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
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 11/2022

13-05-2022 | Magnetic Resonance Imaging | Emergency Radiology

MRI dedicated to the emergency department for diplopia or dizziness: a cost-effectiveness analysis

Authors: Sabrina Kepka, Kevin Zarca, François Lersy, Mylène Moris, Julien Godet, Jeanne Deur, Marie Stoessel, Joris Muller, Pierrick Le Borgne, Seyyid Baloglu, Marie Céline Fleury, Mathieu Anheim, Pascal Bilbault, Guillaume Bierry, Isabelle Durand Zaleski, Stéphane Kremer

Published in: European Radiology | Issue 11/2022

Login to get access

Abstract

Objectives

The purpose of this study was to compare the costs and organizational benefits of diagnostic workup without and with MRI dedicated to the ED.

Methods

We conducted a prospective observational uncontrolled before-after study in one ED of a university hospital in France from July 1, 2018, and January 3, 2020. We included all consecutive patients presenting with dizziness or diplopia. The main outcomes were the clinical decision time of ED physicians and the total costs for each strategy. Outcomes were compared using propensity score with inverse probability weighting in the 2 arms and an incremental cost-effectiveness ratio (ICER) was calculated.

Results

Among the 199 patients during the “before” period (average age: 60.4 years ± 17.6): 112 men (57%), and 181 during the “after” period (average age, 54.8 years ± 18.5): 107 men (59%), the average costs were €2701 (95% CI 1918; 3704) and €2389 (95% CI: €1627; 3280) per patient, respectively. The average time to clinical decision was 9.8 h (95% CI: 8.9 10.7) in the group “before” and 7.7 h (95% CI: 7.1; 8.4) in the group “after” (ICER: €151 saved for a reduction of 1 h in clinical decision time). The probabilistic sensitivity analysis estimated a 71% chance that the MRI dedicated to ED was dominant (less costly and more effective).

Conclusion

Easy access to MRI in the ED for posterior circulation stroke-like symptoms must be considered a relevant approach to help physicians for an appropriate and rapid diagnostic with reduction of costs.

Trial registration

NCT03660852

Key Points

• A dedicated MRI in the ED for diplopia or dizziness may be considered an efficient strategy improving diagnostic performance, reducing physicians’ decision time, and decreasing hospital costs.
• This strategy supports clinical decision-making with early treatment and management of patients with posterior circulation-like symptoms in the ED.
• There is 71% chance that the MRI dedicated to ED was dominant (less costly and more effective) compared with a strategy without dedicated MRI.
Appendix
Available only for authorised users
Literature
1.
Tarnutzer AA, Berkowitz AL, Robinson KA, Hsieh YH, Newman-Toker DE (2011) Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ 183:571–592CrossRef
2.
Fisher CM (1967) Vertigo in cerebrovascular disease. Arch Otolaryngol 85:529–534CrossRef
3.
Edlow JA, Newman-Toker DE, Savitz SI (2008) Diagnosis and initial management of cerebellar infarction. Lancet Neurol 7:951–964CrossRef
4.
Shake A, Oostema A, Jones J (2018) BET 2: missed diagnosis of ischemic stroke in the emergency department. Emerg Med J 35:768–769
5.
Edlow JA, Newman-Toker DE, Savitz SI (2008) Diagnosis and initial management of cerebellar infarction. Lancet Neurol 7:951–964CrossRef
6.
Savitz SI, Caplan LR, Edlow JA (2007) Pitfalls in the diagnosis of cerebellar infarction. Acad Emerg Med 14:63–68CrossRef
7.
Tohgi H, Takahashi S, Chiba K, Hirata Y (1993) Cerebellar Infarction Study Group Cerebellar infarction. Clinical and neuroimaging analysis in 293 patients. Stroke 24:1697–1701CrossRef
8.
Newman-Toker DE, Hsieh YH, Camargo CA Jr, Pelletier AJ, Butchy GT (2008) Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc 83:765–775CrossRef
9.
Kontorinis G (2018) The imaging of the dizzy patient: computed tomography versus magnetic resonance imaging. Eur Radiol 28:2914–2915CrossRef
10.
Ljunggren M, Persson J, Salzer J (2017) Dizziness and the acute vestibular syndrome at the emergency department: a population-based descriptive study. Eur Neurol 79:5–12CrossRef
11.
Saber Tehrani AS, Coughlan D, Hsieh YH et al (2013) Rising annual costs of dizziness presentations to U.S. emergency departments. Acad Emerg Med 20:689–696CrossRef
12.
De Lott LB, Kerber KA, Lee PP, Brown DL, Burke JF (2017) Diplopia-related ambulatory and emergency department visits in the united states, 2003-2012. JAMA Ophtalmol 135:1339–1344CrossRef
13.
Redd V, Levin S, Toerper M, Creel A, Peterson S (2015) Effects of fully accessible magnetic resonance imaging in the emergency department. Acad Emerg Med 22:741–749CrossRef
14.
Honig SE, Babiarz LS, Honig EL, Mirbagheri S, Urrutia V, Yousem DM (2017) The impact of installing an MR scanner in the emergency department for patients presenting with acute stroke-like symptoms. Clin Imaging 45:65–70CrossRef
15.
Buller M, Karis JP (2017) Introduction of a dedicated emergency department MR imaging scanner at the barrow neurological institute. AJNR Am J Neuroradiol 38:1480–1485CrossRef
16.
Ahsan SF, Syamal MN, Yaremchuk K, Peterson E, Seidman M (2013) The costs and utility of imaging in evaluating dizzy patients in the emergency room. Laryngoscope 123:2250–2253CrossRef
17.
Chalela JA, Kidwell CS, Nentwich LM et al (2007) Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet 369:293–298CrossRef
18.
Mullins ME, Schaefer PW, Sorensen AG et al (2002) CT and conventional and diffusion-weighted MR imaging in acute stroke: study in 691 patients at presentation to the emergency department. Radiology 224:353–360CrossRef
19.
Kabra R, Robbie H, Connor SE (2015) Diagnostic yield and impact of MRI for acute ischemic stroke in patients presenting with dizziness and vertigo. Clin Radiol 70:736–742CrossRef
20.
Marin JR, Mills AM (2015) Developing a research agenda to optimize diagnostic imaging in the emergency department: an executive summary of the 2015 Academic Emergency Medicine Consensus Conference. Acad Emerg Med 22:1363–1371CrossRef
21.
22.
Husereau D, Drummond M, Petrou S et al (2013) ISPOR Health Economic Evaluation Publication Guidelines-CHEERS Good Reporting Practices Task Force. Consolidated Health Economic Evaluation Reporting Standards (CHEERS)--explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health 16:231–250CrossRef
23.
24.
25.
26.
Venkat A, Cappelen-Smith C, Askar S et al (2018) Factors associated with stroke misdiagnosis in the emergency department: a retrospective case-control study. Neuroepidemiology 51:123–127CrossRef
27.
Burns JD, Rindler RS, Carr C et al (2016) Delay in diagnosis of basilar artery stroke. Neurocrit Care 24:172–179CrossRef
28.
29.
Dang W, Kielar AZ, Fu AY, Chong ST, McInnes MD (2015) Does distance matter? Effect of having a dedicated CT scanner in the emergency department on completion of CT imaging and final patient disposition times. J Am Coll Radiol 12:277–283CrossRef
30.
Girot M, Marc JB, Wiel E et al (2017) Impact on patient management of the implementation of a magnetic resonance imaging dedicated to neurological emergencies. J Eval Clin Pract 23:1180–1186CrossRef
31.
Machner B, Choi JH, Trillenberg P, Heide W, Helmchen C (2020) Risk of acute brain lesions in dizzy patients presenting to the emergency room: who needs imaging and who does not? J Neurol 267:126–135CrossRef
32.
Tarnutzer AA, Berkowitz AL, Robinson KA, Hsieh YH, Newman-Toker DE (2011) Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ 183(9):E571–E592CrossRef
33.
Newman-Toker DE, Kerber KA, Hsieh YH et al (2013) HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness. Acad Emerg Med 20(10):986–996CrossRef
34.
Krishnan K, Bassilious K, Eriksen E et al (2019) Posterior circulation stroke diagnosis using HINTS in patients presenting with acute vestibular syndrome: a systematic review. Eur Stroke J 4(3):233–239CrossRef
Metadata
Title
MRI dedicated to the emergency department for diplopia or dizziness: a cost-effectiveness analysis
Authors
Sabrina Kepka
Kevin Zarca
François Lersy
Mylène Moris
Julien Godet
Jeanne Deur
Marie Stoessel
Joris Muller
Pierrick Le Borgne
Seyyid Baloglu
Marie Céline Fleury
Mathieu Anheim
Pascal Bilbault
Guillaume Bierry
Isabelle Durand Zaleski
Stéphane Kremer
Publication date
13-05-2022
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-022-08791-7

Other articles of this Issue 11/2022

European Radiology 11/2022 Go to the issue

Editorial Comment

Contrast-enhanced mammography for screening recalls: a problem-solving assessment tool ready for use?

Imaging Informatics and Artificial Intelligence

Development and validation of a combined nomogram model based on deep learning contrast-enhanced ultrasound and clinical factors to predict preoperative aggressiveness in pancreatic neuroendocrine neoplasms

Musculoskeletal

A handbook for beginners in skeletal muscle diffusion tensor imaging: physical basis and technical adjustments

Head and Neck

Ultrasound-guided microwave and radiofrequency ablation for primary hyperparathyroidism: a prospective, multicenter study

Chest

Systemic-pulmonary collateral supply associated with clinical severity of chronic thromboembolic pulmonary hypertension: a study using intra-aortic computed tomography angiography

Magnetic Resonance

Performance of adding hepatobiliary phase image in magnetic resonance imaging for detection of hepatocellular carcinoma: a meta-analysis