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MRI usage in a pediatric emergency department: an analysis of usage and usage trends over 5 years
Meir H Scheinfeld1, Jee-Young Moon2, Michele J Fagan3
1Department of Radiology, Division of Emergency Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E. 210 Street, Bronx, NY, 10467, USA. mscheinf@montefiore.org.
Background:
Magnetic resonance imaging (MRI) usage has anecdotally increased due to the principles of ALARA and the desire to Image Gently. Aside from a single abstract in the emergency medicine literature, pediatric emergency department MRI usage has not been described.
Objecive:
Our objective was to determine whether MRI use is indeed increasing at a high-volume urban pediatric emergency department with 24/7 MRI availability. Also, we sought to determine which exams, time periods and demographics influenced the trend.
Materials And Methods:
Institutional Review Board exemption was obtained. Emergency department patient visit and exam data were obtained from the hospital database for the 2011-2015 time period. MRI usage data were normalized using emergency department patient visit data to determine usage rates. The z-test was used to compare MRI use by gender. The chi-square test was used to test for trends in MRI usage during the study period and in patient age. MRI usage for each hour and each weekday were tabulated to determine peak and trough usage times.
Results:
MRI usage rate per emergency department patient visit was 0.36%. Headache, pain and rule-out appendicitis were the most common indications for neuroradiology, musculoskeletal and trunk exams, respectively. Usage in female patients was significantly greater than in males (0.42% vs. 0.29%, respectively, P<0.001). Usage significantly increased during the 5-year period (P<0.001). Use significantly increased from age 3 to 17 (0.011% to 1.1%, respectively, P<0.001). Sixty percent of exams were performed after-hours, the highest volume during the 10 p.m. hour and lowest between 4 a.m. and 9 a.m. MRI use was highest on Thursdays and lowest on Sundays (MRI on 0.45% and 0.22% of patients, respectively).
Conclusion:
MRI use in children increased during the study period, most notably in females, on weekdays and after-hours.
Insights
Pediatric emergency department magnetic resonance imaging (MRI) use increased significantly from 2011-2015, particularly in females and during after-hours periods. This trend aligns with imaging guidelines for pediatric patients.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Medical Imaging Trends
Background:
- Growing emphasis on ALARA (As Low As Reasonably Achievable) and Image Gently principles has anecdotally increased MRI utilization.
- Limited data exists on pediatric emergency department MRI usage trends.
Purpose of the Study:
- To assess the trend of MRI use in a high-volume urban pediatric emergency department with 24/7 availability.
- To identify specific exams, time periods, and demographics influencing MRI usage trends.
Main Methods:
- Retrospective analysis of emergency department patient visit and MRI exam data from 2011-2015.
- Normalized MRI usage rates by patient visits.
- Statistical analysis (z-test, chi-square) to evaluate trends by gender, age, time of day, and day of week.
Main Results:
- Overall MRI usage rate was 0.36% of emergency department visits.
- Significant increases in MRI use were observed over the 5-year study period (P<0.001) and with increasing age (3-17 years).
- Female patients showed higher MRI usage (0.42% vs. 0.29%, P<0.001); 60% of exams occurred after-hours, with peak usage at 10 p.m. and highest volume on Thursdays.
Conclusions:
- Pediatric emergency department MRI utilization has demonstrably increased.
- This rise is most pronounced in female patients, during weekdays, and outside of standard working hours.
- Findings support the need for continued monitoring of pediatric imaging practices.
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