Hajibonabi Farid, Cohen-Addad Dan, Delgado Francisco, Chen Po-Han, Wang Bing Fang, Das Shamie, Hanna Tarek N
Emory University School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, Georgia.
Agusta University Medical College of Georgia, Department of Radiology, Atlanta, Georgia.
West J Emerg Med. 2025 Jul 12;26(4):936-942. doi: 10.5811/westjem.32802.
Prolonged emergency department (ED) waiting times for STAT spine magnetic resonance imaging (MRI) in the ED can expose patients to hospital-acquired infections and increase the workload in the ED, further impacting healthcare quality. In this study we aimed to characterize emergent spine MRI frequency and positivity in the ED, and its impact on ED length of stay (LOS), admission rates, and the necessity for surgical interventions.
We performed a retrospective chart review of a consecutive group of patients who had emergent spine MRI (cervical, thoracic, lumbar) ordered from the EDs at four hospitals from January 1, 2017-December 31,2022 were included for traumatic and atraumatic patients. We recorded patient demographics, time metrics, discharge status, and surgical interventions within seven days (for those who were hospitalized during the ED encounter). Spine MRI reports were reviewed and categorized, with positive cases defined as severe spinal canal stenosis regardless of cause and/or fracture. We used descriptive statistics to assess the positivity rate for emergent spine MRIs as well as the LOS, rate of surgery, and rate of admission for patients getting emergent spine MRIs.
A total of 689 spine MRI of 889,527 ED visits (0.1%) were included. Patients' mean age was 51.3 ±17.1 years, and 59.5% were female. Discharge rate was 93.9%, 3.3% were admitted, 1.7% left against medical advice, and 1.0% were transferred to other facilities. The overall spine MRI positivity rate was 18.9% (130). Moreover, the median (IQR) time from imaging order placement to imaging completion was 2.6 (1.8 - 3.7) hours, while the time from imaging completion to final report availability was 1.5 (0.4 - 13.9) hours. The median ED LOS was 7.4 (5.7 - 9.5) hours. Of 23 hospitalized patients, 17 (73.9%) required surgical intervention. Positive cases had significantly higher ED LOS compared to negative cases (8.1 vs 7.2, respectively; P < .001).
The positivity rate for ED spine MRI in this study was 18.9%. Of the positive cases, 17.7% underwent hospitalization, with 13.1% requiring emergent surgery. Considering high costs in both time and resource utilization, further research is needed to optimize the triage process for patients requiring emergent spine MRI.
急诊科（ED）中脊柱磁共振成像（MRI）紧急检查的等待时间过长，可能会使患者面临医院获得性感染的风险，并增加急诊科的工作量，进而影响医疗质量。在本研究中，我们旨在描述急诊科脊柱MRI紧急检查的频率和阳性率，及其对急诊科住院时间（LOS）、住院率和手术干预必要性的影响。
我们对2017年1月1日至2022年12月31日期间在四家医院急诊科接受紧急脊柱MRI（颈椎、胸椎、腰椎）检查的连续患者组进行了回顾性病历审查，纳入了创伤性和非创伤性患者。我们记录了患者的人口统计学信息、时间指标、出院状态以及七天内的手术干预情况（对于在急诊科就诊期间住院的患者）。对脊柱MRI报告进行了审查和分类，阳性病例定义为无论病因如何的严重椎管狭窄和/或骨折。我们使用描述性统计来评估紧急脊柱MRI的阳性率以及接受紧急脊柱MRI检查患者的住院时间、手术率和住院率。
在889,527次急诊科就诊中，共纳入689例脊柱MRI检查（0.1%）。患者的平均年龄为51.3±17.1岁，女性占59.5%。出院率为93.9%，3.3%住院，1.7%自动出院，1.0%转至其他医疗机构。脊柱MRI总体阳性率为18.9%（130例）。此外，从成像订单下达至成像完成的中位时间（IQR）为2.6（1.8 - 3.7）小时，而成像完成至最终报告可用的时间为1.5（0.4 - 13.9）小时。急诊科中位住院时间为7.4（5.7 - 9.5）小时。在23例住院患者中，17例（73.9%）需要手术干预。阳性病例的急诊科住院时间显著长于阴性病例（分别为8.1小时和7.2小时；P <.001）。
本研究中急诊科脊柱MRI的阳性率为18.9%。在阳性病例中，17.7%住院，13.1%需要紧急手术。考虑到时间和资源利用方面的高成本，需要进一步研究以优化需要紧急脊柱MRI检查患者的分诊流程。
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