Yale School of Medicine, New Haven, CT.
Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT.
Ann Emerg Med. 2018 Jan;71(1):64-73. doi: 10.1016/j.annemergmed.2017.07.006. Epub 2017 Aug 18.
Use of magnetic resonance imaging (MRI) for cervical clearance after a negative cervical computed tomography (CT) scan result in alert patients with blunt trauma who are neurologically intact is not infrequent, despite poor evidence in regard to its utility. The objective of this study is to evaluate the utility and cost-effectiveness of using MRI versus no follow-up in this patient population.
A modeling-based decision analysis was performed during the lifetime of a 40-year-old individual from a societal perspective. The 2 strategies compared were no follow-up and MRI. A Markov model with a 3% discount rate was used with parameters from the literature. Base cases and probabilistic and sensitivity analyses were performed to assess the cost-effectiveness of the strategies.
The cost of MRI follow-up was $11,477, with a health benefit of 24.03 quality-adjusted life-years; the cost of no follow-up was $6,432, with a health benefit of 24.08 quality-adjusted life-years. No follow-up was the dominant strategy, with a lower cost and a higher utility. Probabilistic sensitivity analysis showed no follow-up to be the better strategy in all 10,000 iterations. No follow-up was the better strategy irrespective of the negative predictive value of initial CT result, and it remained the better strategy when the incidence of missed unstable injury resulting in permanent neurologic deficits was less than 64.2% and the incidence of patients immobilized with a hard collar who still received cord injury was greater than 19.7%. Multiple 3-way sensitivity analyses were performed.
MRI is not cost-effective for further evaluation of unstable injury in neurologically intact patients with blunt trauma after a negative cervical spine CT result.
尽管缺乏其效用的相关证据，但在神经完整的钝器伤意识警觉患者中，对于颈椎 CT 扫描阴性结果的患者，使用磁共振成像（MRI）进行颈椎减压并不少见。本研究旨在评估在这类患者人群中，与不进行随访相比，使用 MRI 的效用和成本效益。
从社会角度对一名 40 岁个体的终生进行基于模型的决策分析。比较的两种策略是不进行随访和 MRI。使用来自文献的参数，采用具有 3%贴现率的 Markov 模型。进行基本案例和概率及敏感性分析，以评估这些策略的成本效益。
MRI 随访的费用为 11477 美元，健康效益为 24.03 个质量调整生命年；不进行随访的费用为 6432 美元，健康效益为 24.08 个质量调整生命年。不进行随访是更具成本效益的策略，具有更低的成本和更高的效用。概率敏感性分析表明，在所有 10000 次迭代中，不进行随访都是更好的策略。无论初始 CT 结果的阴性预测值如何，不进行随访都是更好的策略，当导致永久性神经功能缺损的不稳定损伤的发生率小于 64.2%，以及仍接受脊髓损伤但佩戴硬领固定的患者的发生率大于 19.7%时，不进行随访仍然是更好的策略。进行了多次三向敏感性分析。
对于颈椎 CT 扫描阴性结果的神经完整钝器伤患者，MRI 对于进一步评估不稳定损伤并不具有成本效益。
