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Clinical Value and Operational Risks of MRI in ICU patients - A Retrospective Analysis Performed at a University
Michael T Pawlik1, Lena M Dendl2, Lom-Ali Achajew1
1Anaesthesiology and Intensive Care Medicine, Caritas-Krankenhaus Sankt Josef Regensburg, Germany.
Purpose:
Intensive care unit (ICU) patients have a high risk of developing complications when leaving the ICU for diagnostic procedures or therapeutic interventions. Our study examined the frequency of adverse events associated with magnetic resonance imaging (MRI) of intensive care patients and the extent of changes in therapy due to the MRI scan to weigh the risks associated with the scan against the potential benefits of an MR scan, using a change in therapy as an indicator of benefit.
Materials And Methods:
4434 ICU patients (January to December 2015) were identified by Hospital Information System (SAP-R/3 IS-H, Walldorf, Germany), ICU patient data management system Metavision (iMDsoft, Israel), and Radiology Information System (Nexus.medRIS, Version 8.42, Nexus, Germany). All intensive care and medical records (HIS) and MRI reports (RIS) were matched and further evaluated in a retrospective case-to-case analysis for biometric data, mechanical ventilation, ICU requirements, planned postoperative vs. emergency diagnostic requirements, complications and impact on further diagnosis or therapy.
Results:
Out of 4434 ICU patients, 322 ICU patients (7.3 %) underwent a total of 385 MRI examinations. 167 patients needed a total of 215 emergency scans, while 155 patients underwent 170 planned postoperative MRI exams. 158 (94.6 %) out of 167 emergency scan patients were ventilated under continuous intravenous medication and monitoring. In the planned postoperative group, only 6 (3.9 %) out of 155 were ventilated, but a total of 38 (24.5 %) were under continuous medication. 111 patients were accompanied by nurses only during MRI. Only one severe adverse event (0.3 %) was noted and was attributed to study preparation (n = 385). In 8 MRI examinations (2.1 %), the examination was interrupted or cancelled due to the patients' condition. While all MRI examinations in the planned group were completed (n = 170, 100 %) (e. g., postoperative controls), only 207 out of 215 (96.3 %) could be performed for emergency diagnostic reasons. MRI influenced the clinical course with a change in diagnosis or therapy in 74 (19.2 %) of all 385 MRI examinations performed, and in the emergency diagnostic group it was 31.2 % (n = 67/215).
Conclusion:
Nearly 20 % of MRI examinations of ICU patients resulted in a change of therapy. With only one potentially life-threatening adverse event (0.3 %) during transport and the MRI examination, the risk seems to be outweighed by the diagnostic benefit.
Key Points:
· The risk of adverse events associated with MRI scans in ICU patients is low.. · The rate of premature termination of ICU patients' MRI scans is low.. · Almost 20 % of ICU patients' MRI scans lead to a change of therapy..
Insights
Magnetic resonance imaging (MRI) scans for intensive care unit (ICU) patients carry a low risk of adverse events. The diagnostic benefits, indicated by a nearly 20% rate of therapy changes, outweigh the minimal risks associated with these MRI procedures.
Area of Science:
- Radiology
- Intensive Care Medicine
- Patient Safety
Background:
- Intensive care unit (ICU) patients face increased risks during diagnostic procedures outside the ICU.
- Magnetic resonance imaging (MRI) offers significant diagnostic capabilities but requires careful risk-benefit assessment for critically ill patients.
Purpose of the Study:
- To evaluate the frequency of adverse events during MRI scans in ICU patients.
- To determine the impact of MRI scans on patient therapy, using changes in treatment as a measure of diagnostic benefit.
Main Methods:
- Retrospective analysis of 385 MRI examinations in 322 ICU patients between January and December 2015.
- Data collected included patient demographics, ventilation status, medication, and reasons for MRI (emergency vs. planned).
- Adverse events and changes in diagnosis or therapy post-MRI were recorded.
Main Results:
- Only one severe adverse event (0.3%) occurred, attributed to preparation.
- 8 MRI examinations (2.1%) were interrupted or cancelled due to patient condition.
- MRI influenced diagnosis or therapy in 19.2% of cases, with a higher rate (31.2%) in emergency scans.
Conclusions:
- The risk of adverse events during MRI for ICU patients is low.
- MRI scans provide significant diagnostic benefits, often leading to changes in patient management.
- The diagnostic advantages of MRI in the ICU setting appear to outweigh the associated risks.
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