Orthopaedic Institute for Children and UCLA Department of Orthopaedic Surgery.
David Geffen School of Medicine at UCLA.
J Pediatr Orthop. 2020 Nov/Dec;40(10):e952-e957. doi: 10.1097/BPO.0000000000001653.
Increased enrollment in government-based insurance plans has been reported. With youth sports injuries on the rise, increased ordering of advanced imaging such as magnetic resonance imaging (MRI) has occurred. This study sought to report on the impact of insurance type on access to and results of knee MRI in pediatric sports medicine patients.
A retrospective review of 178 consecutive pediatric sports medicine clinics was completed.
patients younger than 18 years, routine knee MRI ordered, sports medicine diagnosis, and insurance. Data included basic demographics, injury date, date and location (urgent care vs. clinic) of the first presentation, details of MRI ordering and approval, date and location of MRI follow-up, MRI results (negative, minor findings, major findings), and eventual treatment required.
A total of 168 charts underwent a complete review. The patients' average age was 14±3 years and 54% (N=90) were female. Ninety-eight had government insurance and 70 had commercial insurance. The time between injury and MRI completion was significantly longer with government insurance (34 vs. 67 d, P<0.01). Government insurance had increased wait time between the first visit and MRI completion (11 vs. 40 d, P<0.001) as well as MRI order and completion (9 vs. 16.5 d, P<0.001). There was no significant difference in positive findings on MRI between insurance groups, including both major and minor findings nor in the proportion receiving eventual operative treatment.
Pediatric sports medicine patients with government insurance have delays in obtaining knee MRI, despite there being no difference in the rate of positive findings and subsequent operative treatments.
Level III-case-control study.
政府保险计划的参保人数有所增加。随着青少年运动损伤的增加，磁共振成像（MRI）等高级影像学检查的需求也有所增加。本研究旨在报告保险类型对小儿运动医学患者膝关节 MRI 检查的可及性和结果的影响。
对 178 例连续的小儿运动医学诊所进行回顾性研究。
年龄小于 18 岁，常规行膝关节 MRI 检查，运动医学诊断，以及有保险。数据包括基本人口统计学信息、损伤日期、首次就诊的日期和地点（急诊或诊所）、MRI 检查和批准的详细信息、MRI 随访的日期和地点、MRI 结果（阴性、轻微发现、主要发现）以及最终需要的治疗。
共有 168 份病历进行了完整审查。患者的平均年龄为 14±3 岁，其中 54%（N=90）为女性。98 例患者有政府保险，70 例有商业保险。政府保险组从损伤到 MRI 完成的时间明显更长（34 天 vs. 67 天，P<0.01）。政府保险组在首次就诊和 MRI 完成之间的等待时间更长（11 天 vs. 40 天，P<0.001），MRI 检查申请和完成之间的等待时间也更长（9 天 vs. 16.5 天，P<0.001）。两组间 MRI 阳性发现率（包括主要发现和次要发现）以及最终接受手术治疗的比例均无显著差异。
尽管政府保险组的小儿运动医学患者 MRI 阳性发现率和随后的手术治疗率没有差异，但他们在获得膝关节 MRI 检查方面存在延迟。
III 级病例对照研究。
