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Intraoperative Ultrasound in Spinal Surgery
Published on: August 17, 2022
Utility of Emergent Spine MRI in the Emergency Department
Farid Hajibonabi1, Dan Cohen-Addad1, Francisco Delgado1
1Emory University School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, Georgia.
Introduction:
Prolonged emergency department (ED) waiting times for STAT spine magnetic resonance imaging (MRI) in the ED can expose patients to hospital-acquired infections and increase the workload in the ED, further impacting healthcare quality. In this study we aimed to characterize emergent spine MRI frequency and positivity in the ED, and its impact on ED length of stay (LOS), admission rates, and the necessity for surgical interventions.
Methods:
We performed a retrospective chart review of a consecutive group of patients who had emergent spine MRI (cervical, thoracic, lumbar) ordered from the EDs at four hospitals from January 1, 2017-December 31,2022 were included for traumatic and atraumatic patients. We recorded patient demographics, time metrics, discharge status, and surgical interventions within seven days (for those who were hospitalized during the ED encounter). Spine MRI reports were reviewed and categorized, with positive cases defined as severe spinal canal stenosis regardless of cause and/or fracture. We used descriptive statistics to assess the positivity rate for emergent spine MRIs as well as the LOS, rate of surgery, and rate of admission for patients getting emergent spine MRIs.
Results:
A total of 689 spine MRI of 889,527 ED visits (0.1%) were included. Patients' mean age was 51.3 ±17.1 years, and 59.5% were female. Discharge rate was 93.9%, 3.3% were admitted, 1.7% left against medical advice, and 1.0% were transferred to other facilities. The overall spine MRI positivity rate was 18.9% (130). Moreover, the median (IQR) time from imaging order placement to imaging completion was 2.6 (1.8 - 3.7) hours, while the time from imaging completion to final report availability was 1.5 (0.4 - 13.9) hours. The median ED LOS was 7.4 (5.7 - 9.5) hours. Of 23 hospitalized patients, 17 (73.9%) required surgical intervention. Positive cases had significantly higher ED LOS compared to negative cases (8.1 vs 7.2, respectively; P < .001).
Conclusion:
The positivity rate for ED spine MRI in this study was 18.9%. Of the positive cases, 17.7% underwent hospitalization, with 13.1% requiring emergent surgery. Considering high costs in both time and resource utilization, further research is needed to optimize the triage process for patients requiring emergent spine MRI.
Insights
Emergency department spine MRI scans are infrequent but can indicate serious conditions. Nearly 19% of scans were positive, with a significant portion of hospitalized patients requiring surgery.
Area of Science:
- Radiology
- Emergency Medicine
- Neurosurgery
Background:
- Prolonged emergency department (ED) waiting times for STAT spine MRI can lead to hospital-acquired infections and increased ED workload.
- Characterizing emergent spine MRI frequency and positivity is crucial for understanding its impact on patient care and hospital resources.
Purpose of the Study:
- To determine the frequency and positivity rate of emergent spine MRIs ordered from the ED.
- To analyze the impact of emergent spine MRIs on ED length of stay (LOS), admission rates, and surgical intervention necessity.
Main Methods:
- Retrospective chart review of emergent spine MRIs (cervical, thoracic, lumbar) from four hospitals (2017-2022).
- Data collected included patient demographics, time metrics, discharge status, and surgical interventions within seven days.
- Spine MRI reports were reviewed to define positive cases (severe spinal canal stenosis and/or fracture).
Main Results:
- 689 spine MRIs were performed out of 889,527 ED visits (0.1%).
- The overall spine MRI positivity rate was 18.9%.
- Median ED LOS was 7.4 hours; positive cases had significantly higher ED LOS (8.1 hours) compared to negative cases (7.2 hours).
- Of hospitalized patients with positive MRIs, 73.9% required surgical intervention.
Conclusions:
- The positivity rate for ED spine MRI was 18.9%, with 17.7% of positive cases leading to hospitalization and 13.1% requiring emergent surgery.
- High costs in time and resource utilization necessitate further research to optimize triage for emergent spine MRI.
- Findings highlight the importance of efficient MRI interpretation and patient management pathways in the ED.
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