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Growing Utilization of Total Spine MRI Relative to Localized Spine MRI for Patients Presenting Through Emergency
Katelyn E Rudisill1, Meera M Dhodapkar, Philip P Ratnasamy
1From the Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT.
Background:
Spine MRI is increasingly considered for patients presenting through the emergency department (ED). It was hypothesized that more MRIs are being obtained of the entire spine (relative to localized regions) over time, and there are inconsistencies in this practice.
Methods:
Data were abstracted from the 2010 to 2021 M151Ortho PearlDiver national, multi-insurance, administrative data set. Patients who received spine MRI within 7 days of presenting through the ED were categorized as having had localized MRI (cervical, thoracic, lumbar, cervical and thoracic, or thoracic and lumbar) or total spine (cervical, thoracic, and lumbar). Patient characteristics were compared between these categories with multivariable analyses. Furthermore, the rate of follow-up MRI within 14 days of initial MRI was assessed and compared.
Results:
Of the 275,999 patients identified as undergoing spine MRI, 93.25% were localized MRI and 6.75% were total spine MRI. Over a decade, total spine MRIs increased from 4.85% in 2010 to 12.38% in 2021 (P < 0.0001). Independent predictive factors for receiving a total spine MRI included indication (trauma, infection, neoplasm with odds ratio [OR], 1.30 relative to degenerative), patient factors (younger age [OR, 1.47 per decade], male sex [OR, 1.21], higher comorbidity [OR, 1.38]), and nonclinical factors (region of the country West [OR, 1.32 relative to South] and insurance plan (Medicaid OR, 1.23 and Medicare OR, 1.10 relative to commercial; P < 0.0001 for each except 0.0005 for Medicare). Follow-up MRIs within 14 days were more likely for total spine MRI than for the localized MRI group (7.28% vs. 5.26%, P < 0.0001).
Discussion:
For patients presenting through the ED, total spine MRIs represent a small but growing minority of spine MRI scans obtained. The nonclinical factors associated with this decision and mildly increased need for follow-up scans after total relative to localized MRI suggest room for greater consistency of practice.
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