Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Pediatric Radiology
Published in: Pediatric Radiology 3/2017

01-03-2017 | Original Article

MRI usage in a pediatric emergency department: an analysis of usage and usage trends over 5 years

Authors: Meir H. Scheinfeld, Jee-Young Moon, Michele J. Fagan, Reubin Davoudzadeh, Dan Wang, Benjamin H. Taragin

Published in: Pediatric Radiology | Issue 3/2017

Login to get access

Abstract

Background

Magnetic resonance imaging (MRI) usage has anecdotally increased due to the principles of ALARA and the desire to Image Gently. Aside from a single abstract in the emergency medicine literature, pediatric emergency department MRI usage has not been described.

Objecive

Our objective was to determine whether MRI use is indeed increasing at a high-volume urban pediatric emergency department with 24/7 MRI availability. Also, we sought to determine which exams, time periods and demographics influenced the trend.

Materials and methods

Institutional Review Board exemption was obtained. Emergency department patient visit and exam data were obtained from the hospital database for the 2011-2015 time period. MRI usage data were normalized using emergency department patient visit data to determine usage rates. The z-test was used to compare MRI use by gender. The chi-square test was used to test for trends in MRI usage during the study period and in patient age. MRI usage for each hour and each weekday were tabulated to determine peak and trough usage times.

Results

MRI usage rate per emergency department patient visit was 0.36%. Headache, pain and rule-out appendicitis were the most common indications for neuroradiology, musculoskeletal and trunk exams, respectively. Usage in female patients was significantly greater than in males (0.42% vs. 0.29%, respectively, P<0.001). Usage significantly increased during the 5-year period (P<0.001). Use significantly increased from age 3 to 17 (0.011% to 1.1%, respectively, P<0.001). Sixty percent of exams were performed after-hours, the highest volume during the 10 p.m. hour and lowest between 4 a.m. and 9 a.m. MRI use was highest on Thursdays and lowest on Sundays (MRI on 0.45% and 0.22% of patients, respectively).

Conclusion

MRI use in children increased during the study period, most notably in females, on weekdays and after-hours.
Literature
1.
Goske MJ, Applegate KE, Boylan J et al (2008) The image gently campaign: working together to change practice. AJR Am J Roentgenol 190:273–274CrossRefPubMed
2.
Ramirez J, Thundiyil J, Cramm-Morgan KJ et al (2010) MRI utilization trends in a large tertiary care pediatric emergency department. Ann Emerg Med 56:S18–S19, Abstract CrossRef
3.
Rankey D, Leach JL, Leach SD (2008) Emergency MRI utilization trends at a tertiary care academic medical center: baseline data. Acad Radiol 15:438–443CrossRefPubMed
4.
5.
Dillman JR, Gadepalli S, Sroufe NS et al (2016) Equivocal pediatric appendicitis: unenhanced MR imaging protocol for nonsedated children-a clinical effectiveness study. Radiology 279:216–225CrossRefPubMed
6.
Moore MM, Kulaylat AN, Brian JM et al (2015) Alternative diagnoses at paediatric appendicitis MRI. Clin Radiol 70:881–889CrossRefPubMed
7.
Koning JL, Naheedy JH, Kruk PG (2014) Diagnostic performance of contrast-enhanced MR for acute appendicitis and alternative causes of abdominal pain in children. Pediatr Radiol 44:948–955CrossRefPubMed
8.
Slater S, Crawford MJ, Kabbouche MA et al (2009) Effects of gender and age on paediatric headache. Cephalalgia 29:969–973CrossRefPubMed
9.
Rosen MP, Ding A, Blake MA et al (2011) ACR Appropriateness Criteria® right lower quadrant pain--suspected appendicitis. J Am Coll Radiol 8:749–755CrossRefPubMed
10.
Pedrosa I, Lafornara M, Pandharipande PV et al (2009) Pregnant patients suspected of having acute appendicitis: effect of MR imaging on negative laparotomy rate and appendiceal perforation rate. Radiology 250:749–757CrossRefPubMed
11.
Linakis JG, Amanullah S, Mello MJ (2006) Emergency department visits for injury in school-aged children in the United States: a comparison of nonfatal injuries occurring within and outside of the school environment. Acad Emerg Med 13:567–570CrossRefPubMed
12.
Goergens ED, McEvoy A, Watson M et al (2005) Acute osteomyelitis and septic arthritis in children. J Paediatr Child Health 41:59–62CrossRefPubMed
13.
Niu X, Xu H, Inwards CY et al (2015) Primary bone tumors: epidemiologic comparison of 9,200 patients treated at Beijing Ji Shui Tan Hospital, Beijing, China, with 10,165 patients at Mayo Clinic, Rochester, Minnesota. Arch Pathol Lab Med 139:1149–1155CrossRefPubMed
14.
Redd V, Levin S, Toerper M et al (2015) Effects of fully accessible magnetic resonance imaging in the emergency department. Acad Emerg Med 22:741–749CrossRefPubMed
15.
Kanzaria HK, Hoffman JR, Probst MA et al (2015) Emergency physician perceptions of medically unnecessary advanced diagnostic imaging. Acad Emerg Med 22:390–398CrossRefPubMed
16.
Boyle TP, Paldino MJ, Kimia AA et al (2014) Comparison of rapid cranial MRI to CT for ventricular shunt malfunction. Pediatrics 134:e47–e54CrossRefPubMed
17.
Wagner MW, Kontzialis M, Seeburg D et al (2016) Acute brain imaging in children: can MRI replace CT as a screening tool? J Neuroimaging 26:68–74CrossRefPubMed
18.
Lell MM, May M, Deak P et al (2011) High-pitch spiral computed tomography: effect on image quality and radiation dose in pediatric chest computed tomography. Investig Radiol 46:116–123CrossRef
19.
Long CM, Long SS, Johnson PT et al (2015) Utility of low-dose high-pitch scanning for pediatric cardiac computed tomographic imaging. J Thorac Imaging 30:W36–W40CrossRefPubMed
20.
Lawhn-Heath C, Buckle C, Christoforidis G et al (2013) Utility of head CT in the evaluation of vertigo/dizziness in the emergency department. Emerg Radiol 20:45–49CrossRefPubMed
21.
Verma RK, Kottke R, Andereggen L et al (2013) Detecting subarachnoid hemorrhage: comparison of combined FLAIR/SWI versus CT. Eur J Radiol 82:1539–1545CrossRefPubMed
22.
Le J, Kurian J, Cohen HW et al (2013) Do clinical outcomes suffer during transition to an ultrasound-first paradigm for the evaluation of acute appendicitis in children? AJR Am J Roentgenol 201:1348–1352CrossRefPubMedPubMedCentral
23.
Leite ED, Seber A, de Barbosa FG et al (2011) Rapid, low-cost MR imaging protocol to document central nervous system and sinus abnormalities prior to pediatric hematopoietic stem cell transplantation. Pediatr Radiol 41:749–756CrossRefPubMed
24.
Morgan CD, Zuckerman SL, King LE et al (2015) Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging. Childs Nerv Syst 31:2305–2309CrossRefPubMed
25.
Pearce MS, Salotti JA, Little MP et al (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380:499–505CrossRefPubMedPubMedCentral
26.
Miglioretti DL, Johnson E, Williams A et al (2013) The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr 167:700–707CrossRefPubMedPubMedCentral
27.
Kocher KE, Meurer WJ, Desmond JS et al (2012) Effect of testing and treatment on emergency department length of stay using a national database. Acad Emerg Med 19:525–534CrossRefPubMed
Metadata
Title
MRI usage in a pediatric emergency department: an analysis of usage and usage trends over 5 years
Authors
Meir H. Scheinfeld
Jee-Young Moon
Michele J. Fagan
Reubin Davoudzadeh
Dan Wang
Benjamin H. Taragin
Publication date
01-03-2017
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Radiology / Issue 3/2017
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-016-3764-y

Other articles of this Issue 3/2017

Pediatric Radiology 3/2017 Go to the issue

Original Article

Assessing colonic anatomy normal values based on air contrast enemas in children younger than 6 years

Original Article

Prevalence of non-cardiovascular findings on CT angiography in children with congenital heart disease

Case Report

Multifocal tenosynovial giant cell tumors in a child with Noonan syndrome

Pediatric Radiology CME Activity

Pediatric Radiology Continuing Medical Education Activity

Review

Imaging of late complications of cancer therapy in children

Original Article

Computed tomography localization of the appendix in the pediatric population relative to the lumbar spine