Naqvi Syed R, Beavis R Cole, Mondal Prosanta, Bryce Rhonda, Leswick David A
Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Division of Orthopedics, Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Orthop J Sports Med. 2021 Nov 11;9(11):23259671211052560. doi: 10.1177/23259671211052560. eCollection 2021 Nov.
The utility of magnetic resonance imaging (MRI) in the primary care setting is uncertain, with a perception that there is less likelihood for surgery after MRI ordered by general practitioners (GPs) when compared with orthopaedic surgeons and sports medicine physicians. Additionally, the influence of patient age and sex on subsequent surgical intervention is currently unknown.
PURPOSE/HYPOTHESIS: The purpose of this study was to compare surgical incidence after MRI referrals by orthopaedic surgeons, GPs, and sports medicine physicians, including a subset analysis for GP patients based on type of approval given by the radiologist. The authors also wanted to explore the association of age and sex on subsequent surgical intervention. They hypothesized that surgical incidence after MRI ordered by orthopaedic surgeons and sports medicine physicians would be higher than after MRI ordered by GPs.
Cohort study; Level of evidence, 3.
Knee MRI referrals by the 3 physician cohorts during May to December 2017 were assessed. For GP patients, the types of approval or recommendation from a radiologist were categorized. Subsequent surgical intervention status was then compared among referral groups up to 2 years after MRI. Associations of age and sex with surgical occurrence were also assessed. Chi-square test, analysis of variance, and univariate/multivariable logistic regression were used for statistical analysis.
Overall, 407 referrals were evaluated (GP, n = 173; orthopaedic, n = 176; sports medicine, n = 58). Surgical incidence was not significantly higher for orthopaedic and sports medicine than GP referrals at 3 months (10%, 3%, and 6%, respectively; = .23), 6 months (20%, 17%, and 15%; = .49), and 2 years (30%, 35%, and 24%; = .25). Surgical incidence for GP patients was higher after discussion with a radiologist or when evaluating specific pathology on prior imaging versus less defined reasons (30.4% vs 15.7%, respectively; = .03). Surgical incidence was lower for older patients (11% vs 31% for >60 years vs all other age groups combined; = .002), and women were less likely to undergo surgery than men (22% vs 35%, respectively; = .008).
Surgical incidence after MRI was likely appropriately lower for older patients. Lower incidence for female patients is of uncertain cause and warrants further study.
磁共振成像（MRI）在基层医疗环境中的实用性尚不确定，人们认为与骨科医生和运动医学医生相比，全科医生（GP）开具MRI检查后进行手术的可能性较小。此外，患者年龄和性别对后续手术干预的影响目前尚不清楚。
目的/假设：本研究的目的是比较骨科医生、全科医生和运动医学医生转诊进行MRI检查后的手术发生率，包括对全科医生转诊患者根据放射科医生给出的批准类型进行亚组分析。作者还想探讨年龄和性别与后续手术干预之间的关联。他们假设骨科医生和运动医学医生开具MRI检查后的手术发生率高于全科医生开具MRI检查后的手术发生率。
队列研究；证据等级，3级。
评估了2017年5月至12月期间这3组医生转诊的膝关节MRI检查。对于全科医生转诊的患者，对放射科医生的批准或建议类型进行了分类。然后比较MRI检查后长达2年的转诊组之间的后续手术干预情况。还评估了年龄和性别与手术发生之间的关联。采用卡方检验、方差分析以及单变量/多变量逻辑回归进行统计分析。
总体而言，共评估了407例转诊病例（全科医生转诊173例；骨科转诊176例；运动医学转诊58例）。在3个月时（分别为10%、3%和6%；P = 0.23）、6个月时（20%、17%和15%；P = 0.49）以及2年时（30%、35%和24%；P = 0.25），骨科和运动医学转诊病例的手术发生率并不显著高于全科医生转诊病例。与放射科医生讨论后或在评估先前影像上的特定病理情况时，全科医生转诊患者的手术发生率高于原因不太明确时（分别为30.4%对15.7%；P = 0.03）。老年患者的手术发生率较低（60岁以上患者为11%，而所有其他年龄组合并为31%；P = 0.002），并且女性接受手术的可能性低于男性（分别为22%对35%；P = 0.008）。
老年患者MRI检查后的手术发生率可能适当较低。女性患者发生率较低的原因尚不确定，值得进一步研究。
