Department of Neurology, 12228Yale University, New Haven, CT, USA.
Department of Neurology, 14434University of Utah, Salt Lake City, UT, USA.
Neuroradiol J. 2023 Apr;36(2):142-147. doi: 10.1177/19714009221108681. Epub 2022 Jun 14.
Abbreviated "rapid MRI" protocols have become more common for the evaluation of acute ischemic stroke (AIS). Prior research has not evaluated the effect of rapid MRIs on cost or hospital length of stay in AIS patients.
We retrospectively identified AIS patients who presented within 6 h of acute neurologic symptom onset to an emergency department (ED) and activated a "brain attack" code. We included sequential patients from January 2012 to September 2015, before rapid MRI was available, who had CT perfusion (CTP) and compared them to patients from October 2015 to May 2018 who had a rapid MRI. We used inverse-probability-weighting (IPW) to balance the cohorts. The primary outcomes were direct cost to our healthcare system and total hospital length of stay (LOS).
We included 408 brain attack activations (mean ± SD age 62.1 ± 17.6 years, 47.8% male): 257 in the CTP cohort and 151 in the MRI cohort. Discharge diagnosis was ischemic stroke in 193/408 (47.3%). After patient matching, we found significant reductions for the MRI cohort in total cost (-18.7%, 95% CI -35.0, -2.4, = 0.02) and hospital LOS (-17.0%, 95% CI -31.2, -2.8, = 0.02), with no difference in ED LOS ( = 0.74) as compared to the CTP cohort.
Although these results are preliminary and hypothesis-generating, we found that the use of a rapid MRI protocol in emergency department brain attacks was associated with a 18.7% reduction in total direct cost and 17% reduction in hospital length of stay.
急性缺血性脑卒中（AIS）的评估中，缩写的“快速 MRI”方案变得越来越普遍。先前的研究尚未评估快速 MRI 对 AIS 患者的成本或住院时间长短的影响。
我们回顾性地确定了在急诊科（ED）出现急性神经症状发作后 6 小时内出现 AIS 并激活“脑卒中”方案的患者。我们纳入了 2012 年 1 月至 2015 年 9 月期间接受 CT 灌注（CTP）的连续患者，并将其与 2015 年 10 月至 2018 年 5 月期间接受快速 MRI 的患者进行比较。我们使用逆概率加权（IPW）来平衡队列。主要结局是我们医疗系统的直接成本和总住院时间（LOS）。
我们纳入了 408 例“脑卒中”激活患者（平均年龄±标准差为 62.1±17.6 岁，47.8%为男性）：CTP 组 257 例，MRI 组 151 例。408 例患者中，出院诊断为缺血性脑卒中的有 193 例（47.3%）。在患者匹配后，我们发现 MRI 组的总费用显著降低（-18.7%，95%CI-35.0，-2.4， =0.02）和住院时间（-17.0%，95%CI-31.2，-2.8， =0.02），而 ED 时间无差异（ =0.74）与 CTP 组相比。
尽管这些结果是初步的，且仅为假说提供依据，但我们发现，在急诊科脑卒中患者中使用快速 MRI 方案与总直接成本降低 18.7%和住院时间缩短 17%有关。
