MRI utilization in pediatric emergency department: An analysis over 5 years

Year 2022, Volume: 39 Issue: 1, 75 - 79, 01.01.2022

Ünal Akça , Burcu Çalışkan , Gülfer Akça , Fatih Çalışkan

Abstract

There are concerns on exposure to radiation especially in pediatric population, as magnetic resonance imaging (MRI) can be used in emergency departments and provides an imaging without radiation; its utilization has recently increased. This study aimed to evaluate MRI utilization trends in patients who underwent a MRI in a pediatric emergency department within a period of five years. Examination data of the patients admitted to pediatric emergency department between 2014 and 2018 were obtained from database of the hospital with the approval of Clinical Research Ethical Committee. Rate of MRI utilization in patients admitted to pediatric emergency department was 0.88%. There was a statistically significant increase in MRI utilization within five years (p<0.001). The rate of male patients (1.24%) who underwent MRI was significantly higher than that of female patients (0.65%) (p<0.0001). There was a statistically significant decrease in MRI utilization by age in all categories (p<0.0001). Neuroradiology imaging was the most common. Complaints at presentation and pre-diagnoses were analyzed. The results of MRI were evaluated by radiologists and 53.9% of the results were normal. The highest rate (46.1%) of MRI utilization was between 4 pm and 12 am in a day. The highest rate of MRI utilization was on Friday and the lowest rate was on Sunday. While MRI utilization has increased in pediatric patients, neuroradiology imaging is the most common type. MRI utilization in pediatric emergency department is higher in male patients and in the early ages.

Keywords

pediatrics, pediatric emergency department, magnetic resonance imaging, clinical indication

References

• 1. Öztürk MA, Güneş T. Acil Hastanın Özellikleri ve Acil Hastaya Yaklaşım. Turkiye Klinikleri J Pediatr – Special Topics. 2004;2(6):519-28 Article Language: TR.
• 2. Goske MJ, Applegate KE, Boylan J, Butler PF, Callahan MJ, Coley BD, et al. The Image Gently campaign: working together to change practice. American Journal of Roentgenology. 2008;190(2), 273-274.
• 3. Raja AS, Wright C, Sodickson AD, Zane RD, Schiff GD, Hanson, R, et al. Negative appendectomy rate in the era of CT: an 18-year perspective. Radiology. 2010;256(2), 460-465.
• 4. Wildermuth S, Knauth M, Brandt T, Winter R, Sartor K, Hacke W. Role of CT angiography in patient selection for thrombolytic therapy in acute hemispheric stroke. Stroke. 1998;29(5), 935-938.
• 5. Sodickson A, Baeyens PF, Andriole KP, Prevedello LM, Nawfel RD, Hanson R, et al. Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology. 2009;251(1), 175-184.
• 6. Smith-Bindman R, Lipson J, Marcus R, Kim KP, Mahesh M, Gould R, et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Archives of internal medicine. 2009;169(22), 2078-2086.
• 7. Donnelly LF. Reducing radiation dose associated with pediatric CT by decreasing unnecessary examinations. American Journal of Roentgenology. 2005;184(2), 655-657.
• 8. Rankey D, Leach JL, Leach SD. Emergency MRI utilization trends at a tertiary care academic medical center: baseline data. Academic radiology. 2008;15(4), 438-443.
• 9. ACR appropriateness criteria, 2006. Available at: http://www.acr.org/ac. Accessed August 10, 2007.
• 10. Rao VM, Parker L, Levin DC, Sunshine J, Bushee G. Use trends and geographic variation in neuroimaging: nationwide Medicare data for 1993 and 1998. American journal of neuroradiology. 2001;22(9), 1643-1649.
• 11. Scheinfeld MH, Moon JY, Fagan MJ, Davoudzadeh R, Wang D, Taragin BH. MRI usage in a pediatric emergency department: an analysis of usage and usage trends over 5 years. Pediatric radiology. 2017; 47(3), 327-332.
• 12. Ahn S, Kim WY, Lim KS, Ryoo SM, Sohn CH, Seo DW, et al. Advanced radiology utilization in a tertiary care emergency department from 2001 to 2010. PLoS One. 2014;9(11), e112650.
• 13. Lourenco AP, Swenson D, Tubbs RJ, Lazarus E. Ovarian and tubal torsion: imaging findings on US, CT, and MRI. Emergency radiology. 2014;21(2), 179-187.
• 14. Aspelund G, Fingeret A, Gross E, Kessler D, Keung C, Thirumoorthi A, et al. Ultrasonography/MRI versus CT for diagnosing appendicitis. Pediatrics. 2014;133(4), 586-593.
• 15. Thieme ME, Leeuwenburgh MM, Valdehueza ZD, Bouman DE, deBruin IG, Schreurs WH, et al. Diagnostic accuracy and patient acceptance of MRI in children with suspected appendicitis. European radiology. 2014;24(3), 630-637.
• 16. Rosen MP, Ding A, Blake MA, Baker ME, Cash BD, Fidler JL, et al. ACR Appropriateness Criteria® right lower quadrant pain—suspected appendicitis. Journal of the American College of Radiology. 2011;8(11), 749-755.
• 17. Pedrosa I, Lafornara M, Pandharipande PV, Goldsmith JD, Rofsky NM. Pregnant patients suspected of having acute appendicitis: effect of MR imaging on negative laparotomy rate and appendiceal perforation rate. Radiology. 2009;250(3), 749-757.
• 18. Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia. 1989;30(4):389-98
• 19. Lüders H, Acharya J, Baumgartner C, Benbadis S, Bleasel A, Burgess R, et al. Semiological seizure classification. Epilepsia. 1998;39(9), 1006-1013.
• 20. Theodore WH, Spencer SS, Wiebe S, Langfitt JT, Ali A, Shafer PO, et al. Epilepsy in North America: a report prepared under the auspices of the global campaign against epilepsy, the International Bureau for Epilepsy, the International League Against Epilepsy, and the World Health Organization. Epilepsia. 2006;47(10), 1700-1722.
• 21. Linakis JG, Amanullah S, Mello MJ. Emergency department visits for injury in school‐aged children in the United States: a comparison of nonfatal injuries occurring within and outside of the school environment. Academic emergency medicine. 2006;13(5), 567-570.
• 22. Goergens ED, McEvoy A, Watson M, Barrett IR. Acute osteomyelitis and septic arthritis in children. Journal of paediatrics and child health. 2005;41(1‐2), 59-62.
• 23. Niu X, Xu H, Inwards CY, Li Y, Ding Y, Letson GD, Bui MM. Primary bone tumors: epidemiologic comparison of 9200 patients treated at Beijing Ji Shui Tan hospital, Beijing, China, with 10 165 patients at Mayo Clinic, Rochester, Minnesota. Archives of Pathology and Laboratory Medicine. 2015;139(9), 1149-1155.
• 24. Ramirez J, Thundiyil J, Cramm-Morgan KJ, Papa L, Dobleman C, Giordano P. MRI utilization trends in a large tertiary care pediatric emergency department. Annals of Emergency Medicine. 2010; 3(56), S18-S19.
• 25. Akman M. Türkiye’de birinci basamağın gücü. Türkiye Aile Hekimliği Dergisi, 2014;18(2), 70-78.
• 26. Oguz KK, Yousem DM, Deluca T, Herskovits EH, Beauchamp NJ. Effect of emergency department CT on neuroimaging case volume and positive scan rates. Academic radiology. 2002;9(9), 1018-1024.
• 27. Kanzaria HK, Hoffman JR, Probst MA, Caloyeras JP, Berry SH, Brook RH. Emergency physician perceptions of medically unnecessary advanced diagnostic imaging. Academic Emergency Medicine. 2015;22(4), 390-398.
• 28. Yeşiltaş A, Erdem R. Defansif Tip Uygulamalarina Yönelik Bir Derleme. Süleyman Demirel Üniversitesi Vizyoner Dergisi. 2018;10(23), 137-150.
• 29. Boyle TP, Paldino MJ, Kimia AA, Fitz BM, Madsen JR, Monuteaux MC., et al. Comparison of rapid cranial MRI to CT for ventricular shunt malfunction. Pediatrics. 2014;134(1), e47-e54.
• 30. Leite ED, Seber A, de Barbosa FG, Ginani VC, Carlesse FC, Gouvea RV, et al. Rapid, low-cost MR imaging protocol to document central nervous system and sinus abnormalities prior to pediatric hematopoietic stem cell transplantation. Pediatric radiology. 2011;41(6), 749-756.
• 31. Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. The Lancet, 2012;380(9840), 499-505.
• 32. Miglioretti DL, Johnson E, Williams A, Greenlee RT, Weinmann S, Solberg LI, et al. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA pediatrics. 2013;167(8), 700-707.