Scheinfeld Meir H, Moon Jee-Young, Fagan Michele J, Davoudzadeh Reubin, Wang Dan, Taragin Benjamin H
Department of Radiology, Division of Emergency Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E. 210 Street, Bronx, NY, 10467, USA.
Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
Pediatr Radiol. 2017 Mar;47(3):327-332. doi: 10.1007/s00247-016-3764-y. Epub 2017 Jan 12.
Magnetic resonance imaging (MRI) usage has anecdotally increased due to the principles of ALARA and the desire to Image Gently. Aside from a single abstract in the emergency medicine literature, pediatric emergency department MRI usage has not been described.
Our objective was to determine whether MRI use is indeed increasing at a high-volume urban pediatric emergency department with 24/7 MRI availability. Also, we sought to determine which exams, time periods and demographics influenced the trend.
Institutional Review Board exemption was obtained. Emergency department patient visit and exam data were obtained from the hospital database for the 2011-2015 time period. MRI usage data were normalized using emergency department patient visit data to determine usage rates. The z-test was used to compare MRI use by gender. The chi-square test was used to test for trends in MRI usage during the study period and in patient age. MRI usage for each hour and each weekday were tabulated to determine peak and trough usage times.
MRI usage rate per emergency department patient visit was 0.36%. Headache, pain and rule-out appendicitis were the most common indications for neuroradiology, musculoskeletal and trunk exams, respectively. Usage in female patients was significantly greater than in males (0.42% vs. 0.29%, respectively, P<0.001). Usage significantly increased during the 5-year period (P<0.001). Use significantly increased from age 3 to 17 (0.011% to 1.1%, respectively, P<0.001). Sixty percent of exams were performed after-hours, the highest volume during the 10 p.m. hour and lowest between 4 a.m. and 9 a.m. MRI use was highest on Thursdays and lowest on Sundays (MRI on 0.45% and 0.22% of patients, respectively).
MRI use in children increased during the study period, most notably in females, on weekdays and after-hours.
由于“尽可能低合理可达到水平（ALARA）”原则以及“轻柔成像”的需求，磁共振成像（MRI）的使用据传闻有所增加。除了急诊医学文献中的一篇摘要外，儿科急诊科MRI的使用情况尚未见描述。
我们的目的是确定在一家24小时提供MRI服务的大型城市儿科急诊科，MRI的使用是否确实在增加。此外，我们试图确定哪些检查、时间段和人口统计学因素影响了这一趋势。
获得了机构审查委员会的豁免。从医院数据库中获取了2011 - 2015年期间急诊科患者就诊和检查数据。使用急诊科患者就诊数据对MRI使用数据进行标准化，以确定使用率。采用z检验比较不同性别的MRI使用情况。使用卡方检验来检验研究期间MRI使用情况和患者年龄的趋势。统计每个小时和每个工作日的MRI使用情况，以确定高峰和低谷使用时间。
每次急诊科患者就诊的MRI使用率为0.36%。头痛、疼痛和排除阑尾炎分别是神经放射学、肌肉骨骼和躯干检查最常见的指征。女性患者的使用率显著高于男性（分别为0.42%和0.29%，P<0.001）。在5年期间使用率显著增加（P<0.001）。从3岁到17岁使用率显著增加（分别从0.011%到1.1%，P<0.001）。60%的检查在非工作时间进行，晚上10点的检查量最高，凌晨4点到9点之间最低。周四的MRI使用量最高，周日最低（分别为0.45%和0.22%的患者接受了MRI检查）。
在研究期间，儿童MRI的使用有所增加，最明显的是在女性、工作日和非工作时间。
