Kyle S. Chen, Daniel McBride, J. Wild, Soyang Kwon, J. Samet, R. Gibly
{"title":"急性小儿肌肉骨骼感染的快速MRI方案消除对比,减少镇静,扫描和解释时间,住院时间和费用","authors":"Kyle S. Chen, Daniel McBride, J. Wild, Soyang Kwon, J. Samet, R. Gibly","doi":"10.55275/jposna-2023-731","DOIUrl":null,"url":null,"abstract":"Introduction: Acute musculoskeletal infections (MSKi) affect >1:6000 children in the United States annually, which could lead to arthritis, chronic infection, limb deformity, and even death. MRI is the gold standard for MSKi diagnosis but traditionally requires contrast and anesthesia, delaying results and slowing treatment decision-making. A rapid MRI protocol is an unsedated MRI with limited non-contrast sequences optimized for fluid detection and diffusion-weighted images to help identify abscesses. The objective of this study was to compare MRI access, timing, treatment, length of stay, and charges between the traditional and rapid MRI protocols among pediatric patients undergoing MSKi evaluation. Methods: A single-center retrospective study was conducted among 128 patients undergoing MSKi evaluation before (“Traditional cohort” [TC] of 60 patients admitted in Jan-Dec 2019) and after implementation of the Rapid MRI protocol (“Rapid cohort” [RC] of 68 patients admitted in Jun 2021-Jul 2022). Demographic, clinical, and charge data were extracted from electronic health records. Mann-Whitney U tests were performed to compare the two groups. Results: Demographics and diagnoses were similar, while rates of sedation and contrast administration were significantly different (53% and 88% in TC versus 4% and 0% in RC). The median time to MRI after ordering was 6.5 hours (IQR=3.2-12.2) in TC and 2.2 hours (IQR=1.1-4.5) in RC (P<0.01). The median duration of MRI was 63.2 minutes (IQR=52.4-85.3) in TC and 24.0 minutes (IQR=18.5-41.1) in RC (P<0.01). The median time between ordering and receiving the MRI final interpretation was 13.5 hours (IQR=2.35-66.3) in TC and 7.0 hours (IQR=1.25- 41.7) in RC (P<0.01). The median hospital length of stay was 5.3 days (IQR=2.7-7.9) in TC and 3.7 days (IQR=1.0-5.8) in RC (P<0.01). The median charges for the entire hospital stay were $48,015 (IQR=$28,086-$88,496) in TC and $33,532 (IQR=$13,622, $54,710) in RC (P<0.01). While 10/68 of Rapid MRIs were canceled or aborted due to patient motion or pain, only 6/68 required repeat MRI with sedation. No infection diagnoses were missed on Rapid imaging. Conclusion: In patients being evaluated for MSKi, the Rapid MRI protocol eliminated contrast and nearly eliminated sedation while leading to improved MRI access, scan and interpretation times, and significant decreases in hospital length of stay and charges. Future steps include continuing quality control, studying interobserver reliability between protocols, and multicenter program expansion. Significance: Pediatric MSKi carry a large treatment burden, and this Rapid MRI protocol improves imaging access while eliminating contrast, decreasing sedation, scan time, length of stay, and hospital charges, with a <10% rescan rate and without missing actionable diagnoses.","PeriodicalId":412478,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"91 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A Rapid MRI Protocol for Acute Pediatric Musculoskeletal Infection Eliminates Contrast, Decreases Sedation, Scan and Interpretation Time, Hospital Length of Stay, and Charges\",\"authors\":\"Kyle S. Chen, Daniel McBride, J. Wild, Soyang Kwon, J. Samet, R. Gibly\",\"doi\":\"10.55275/jposna-2023-731\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Introduction: Acute musculoskeletal infections (MSKi) affect >1:6000 children in the United States annually, which could lead to arthritis, chronic infection, limb deformity, and even death. MRI is the gold standard for MSKi diagnosis but traditionally requires contrast and anesthesia, delaying results and slowing treatment decision-making. A rapid MRI protocol is an unsedated MRI with limited non-contrast sequences optimized for fluid detection and diffusion-weighted images to help identify abscesses. The objective of this study was to compare MRI access, timing, treatment, length of stay, and charges between the traditional and rapid MRI protocols among pediatric patients undergoing MSKi evaluation. Methods: A single-center retrospective study was conducted among 128 patients undergoing MSKi evaluation before (“Traditional cohort” [TC] of 60 patients admitted in Jan-Dec 2019) and after implementation of the Rapid MRI protocol (“Rapid cohort” [RC] of 68 patients admitted in Jun 2021-Jul 2022). Demographic, clinical, and charge data were extracted from electronic health records. Mann-Whitney U tests were performed to compare the two groups. Results: Demographics and diagnoses were similar, while rates of sedation and contrast administration were significantly different (53% and 88% in TC versus 4% and 0% in RC). The median time to MRI after ordering was 6.5 hours (IQR=3.2-12.2) in TC and 2.2 hours (IQR=1.1-4.5) in RC (P<0.01). The median duration of MRI was 63.2 minutes (IQR=52.4-85.3) in TC and 24.0 minutes (IQR=18.5-41.1) in RC (P<0.01). The median time between ordering and receiving the MRI final interpretation was 13.5 hours (IQR=2.35-66.3) in TC and 7.0 hours (IQR=1.25- 41.7) in RC (P<0.01). The median hospital length of stay was 5.3 days (IQR=2.7-7.9) in TC and 3.7 days (IQR=1.0-5.8) in RC (P<0.01). The median charges for the entire hospital stay were $48,015 (IQR=$28,086-$88,496) in TC and $33,532 (IQR=$13,622, $54,710) in RC (P<0.01). While 10/68 of Rapid MRIs were canceled or aborted due to patient motion or pain, only 6/68 required repeat MRI with sedation. No infection diagnoses were missed on Rapid imaging. Conclusion: In patients being evaluated for MSKi, the Rapid MRI protocol eliminated contrast and nearly eliminated sedation while leading to improved MRI access, scan and interpretation times, and significant decreases in hospital length of stay and charges. Future steps include continuing quality control, studying interobserver reliability between protocols, and multicenter program expansion. Significance: Pediatric MSKi carry a large treatment burden, and this Rapid MRI protocol improves imaging access while eliminating contrast, decreasing sedation, scan time, length of stay, and hospital charges, with a <10% rescan rate and without missing actionable diagnoses.\",\"PeriodicalId\":412478,\"journal\":{\"name\":\"Journal of the Pediatric Orthopaedic Society of North America\",\"volume\":\"91 1\",\"pages\":\"0\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the Pediatric Orthopaedic Society of North America\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.55275/jposna-2023-731\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the Pediatric Orthopaedic Society of North America","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.55275/jposna-2023-731","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
简介:在美国,急性肌肉骨骼感染(MSKi)每年影响超过1:6000的儿童,这可能导致关节炎、慢性感染、肢体畸形甚至死亡。MRI是MSKi诊断的金标准,但传统上需要造影剂和麻醉,延迟了结果,减慢了治疗决策。快速MRI方案是一种非镇静MRI,具有有限的非对比序列,优化了液体检测和扩散加权图像,以帮助识别脓肿。本研究的目的是比较传统和快速MRI方案在接受MSKi评估的儿科患者中的MRI访问、时间、治疗、住院时间和费用。方法:对128例接受MSKi评估的患者(60例2019年1- 12月入院的“传统队列”[TC])和实施快速MRI方案后(68例2021年6月- 2022年7月入院的“快速队列”[RC])进行单中心回顾性研究。从电子健康记录中提取人口统计、临床和收费数据。采用Mann-Whitney U检验对两组进行比较。结果:人口统计学和诊断率相似,而镇静和造影剂使用率显著不同(TC为53%和88%,而RC为4%和0%)。TC组下单后到MRI的中位时间为6.5 h (IQR=3.2 ~ 12.2), RC组为2.2 h (IQR=1.1 ~ 4.5) (P<0.01)。MRI中位持续时间TC组为63.2 min (IQR=52.4 ~ 85.3), RC组为24.0 min (IQR=18.5 ~ 41.1) (P<0.01)。TC组下单至接受MRI最终解释的中位时间为13.5小时(IQR=2.35 ~ 66.3), RC组为7.0小时(IQR=1.25 ~ 41.7) (P<0.01)。TC组中位住院时间为5.3 d (IQR=2.7 ~ 7.9), RC组中位住院时间为3.7 d (IQR=1.0 ~ 5.8) (P<0.01)。整个住院期间的中位数费用为TC组$48,015 (IQR=$28,086-$88,496), RC组$33,532 (IQR=$13,622, $54,710) (P<0.01)。而10/68的快速MRI因患者运动或疼痛而取消或流产,只有6/68需要在镇静下重复MRI。快速显像无感染漏诊。结论:在接受MSKi评估的患者中,快速MRI方案消除了造影剂和几乎消除了镇静,同时改善了MRI访问、扫描和解释时间,并显着减少了住院时间和费用。未来的步骤包括继续进行质量控制,研究协议之间的观察者之间的可靠性,以及多中心程序扩展。意义:小儿MSKi承担着巨大的治疗负担,而这种快速MRI方案改善了成像途径,同时消除了造影剂,减少了镇静、扫描时间、住院时间和住院费用,重新扫描率<10%,并且没有遗漏可操作的诊断。
A Rapid MRI Protocol for Acute Pediatric Musculoskeletal Infection Eliminates Contrast, Decreases Sedation, Scan and Interpretation Time, Hospital Length of Stay, and Charges
Introduction: Acute musculoskeletal infections (MSKi) affect >1:6000 children in the United States annually, which could lead to arthritis, chronic infection, limb deformity, and even death. MRI is the gold standard for MSKi diagnosis but traditionally requires contrast and anesthesia, delaying results and slowing treatment decision-making. A rapid MRI protocol is an unsedated MRI with limited non-contrast sequences optimized for fluid detection and diffusion-weighted images to help identify abscesses. The objective of this study was to compare MRI access, timing, treatment, length of stay, and charges between the traditional and rapid MRI protocols among pediatric patients undergoing MSKi evaluation. Methods: A single-center retrospective study was conducted among 128 patients undergoing MSKi evaluation before (“Traditional cohort” [TC] of 60 patients admitted in Jan-Dec 2019) and after implementation of the Rapid MRI protocol (“Rapid cohort” [RC] of 68 patients admitted in Jun 2021-Jul 2022). Demographic, clinical, and charge data were extracted from electronic health records. Mann-Whitney U tests were performed to compare the two groups. Results: Demographics and diagnoses were similar, while rates of sedation and contrast administration were significantly different (53% and 88% in TC versus 4% and 0% in RC). The median time to MRI after ordering was 6.5 hours (IQR=3.2-12.2) in TC and 2.2 hours (IQR=1.1-4.5) in RC (P<0.01). The median duration of MRI was 63.2 minutes (IQR=52.4-85.3) in TC and 24.0 minutes (IQR=18.5-41.1) in RC (P<0.01). The median time between ordering and receiving the MRI final interpretation was 13.5 hours (IQR=2.35-66.3) in TC and 7.0 hours (IQR=1.25- 41.7) in RC (P<0.01). The median hospital length of stay was 5.3 days (IQR=2.7-7.9) in TC and 3.7 days (IQR=1.0-5.8) in RC (P<0.01). The median charges for the entire hospital stay were $48,015 (IQR=$28,086-$88,496) in TC and $33,532 (IQR=$13,622, $54,710) in RC (P<0.01). While 10/68 of Rapid MRIs were canceled or aborted due to patient motion or pain, only 6/68 required repeat MRI with sedation. No infection diagnoses were missed on Rapid imaging. Conclusion: In patients being evaluated for MSKi, the Rapid MRI protocol eliminated contrast and nearly eliminated sedation while leading to improved MRI access, scan and interpretation times, and significant decreases in hospital length of stay and charges. Future steps include continuing quality control, studying interobserver reliability between protocols, and multicenter program expansion. Significance: Pediatric MSKi carry a large treatment burden, and this Rapid MRI protocol improves imaging access while eliminating contrast, decreasing sedation, scan time, length of stay, and hospital charges, with a <10% rescan rate and without missing actionable diagnoses.