PT  - JOURNAL ARTICLE
AU  - C.W.C. Huang
AU  - A. Ali
AU  - Y.-M. Chang
AU  - A.F. Bezuidenhout
AU  - D.B. Hackney
AU  - J.A. Edlow
AU  - R.A. Bhadelia
TI  - Major Radiologic and Clinical Outcomes of Total Spine MRI Performed in the Emergency Department at a Major Academic Medical Center
AID  - 10.3174/ajnr.A6578
DP  - 2020 May 21
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2020/05/21/ajnr.A6578.short
4100  - http://www.ajnr.org/content/early/2020/05/21/ajnr.A6578.full
AB  - BACKGROUND AND PURPOSE: Total spine MRIs are requested by the emergency department when focused imaging can not be ordered on the basis of history or clinical findings. However, their efficacy is not known. We assessed the following: 1) major radiologic and clinical outcomes of total spine MR imaging performed by the emergency department, and 2) whether the presence of a high-risk clinical profile and/or neurologic findings impacts the clinical outcomes.MATERIALS AND METHODS: Total spine MRIs requested by the emergency department during a 28-month period were evaluated for major radiologic (cord compression, cauda equina compression, and other significant findings) and major clinical outcomes (hospital admission during the visit followed by an operation, radiation therapy, or intravenous antibiotics or steroids). Associations between a high-risk clinical profile (cancer, infection, coagulopathy) and/or the presence of neurologic findings and outcomes were assessed.RESULTS: After we excluded trauma or nondiagnostic studies, 321/2047 (15.7%) MRIs ordered during study period were total spine MR imaging; 117/321 (36.4%) had major radiologic and 60/321 (18.6%) had major clinical outcomes (34/60 in <24 hours); and 58/117(49.6%) with major radiologic outcome were treated compared with 2/205 (1.0%) without (OR = 99, P < .001). The presence of both a high-risk clinical profile and neurologic findings concurrently in a patient (142/321) increased the likelihood of major clinical outcomes during the same visit (OR = 3.1, P < .001) and in <24-hours (OR = 2.6, P = .01) compared with those with either a high-risk clinical profile or neurologic findings alone (179/321).CONCLUSIONS: Total spine MR imaging ordered by our emergency department has a high radiologic and significant clinical yield. When a high-risk clinical profile and neurologic findings are both present in a patient, they should be prioritized for emergent total spine MR imaging, given the increased likelihood of clinical impact.CECcauda equina compressionEDemergency departmentHRCPhigh-risk clinical profileSCCspinal cord compressionTStotal spine