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Mazurek MH, Abruzzo AR, King AH, Koranteng E, Rigney G, Lie W, Razak S, Gupta R, Mehan WA, Lev MH, Hirsch JA, Buch K, Succi MD. Implementation of a Survey Spine MR Imaging Protocol for Cord Compression in the Emergency Department: Experience at a Level 1 Trauma Center. AJNR Am J Neuroradiol 2024:ajnr.A8326. [PMID: 38702066 DOI: 10.3174/ajnr.a8326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND PURPOSE Imaging stewardship in the emergency department (ED) is vital in ensuring patients receive optimized care. While suspected cord compression (CC) is a frequent indication for total spine MR imaging in the ED, the incidence of CC is low. Recently, our level 1 trauma center introduced a survey spine MR imaging protocol to evaluate for suspected CC while reducing examination time to avoid imaging overutilization. This study aims to evaluate the time savings, frequency of ordering patterns of the survey, and the symptoms and outcomes of patients undergoing the survey. MATERIALS AND METHODS This retrospective study examined patients who received a survey spine MR imaging in the ED at our institution between 2018 and 2022. All examinations were performed on a 1.5T GE Healthcare scanner by using our institutional CC survey protocol, which includes sagittal T2WI and STIR sequences through the cervical, thoracic, and lumbar spine. Examinations were read by a blinded, board-certified neuroradiologist. RESULTS A total of 2002 patients received a survey spine MR imaging protocol during the study period. Of these patients, 845 (42.2%, mean age 57 ± 19 years, 45% women) received survey spine MR imaging examinations for the suspicion of CC, and 120 patients (14.2% positivity rate) had radiographic CC. The survey spine MR imaging averaged 5 minutes and 50 seconds (79% faster than routine MR imaging). On multivariate analysis, trauma, back pain, lower extremity weakness, urinary or bowel incontinence, numbness, ataxia, and hyperreflexia were each independently associated with CC. Of the 120 patients with CC, 71 underwent emergent surgery, 20 underwent nonemergent surgery, and 29 were managed medically. CONCLUSIONS The survey spine protocol was positive for CC in 14% of patients in our cohort and acquired at a 79% faster rate compared with routine total spine. Understanding the positivity rate of CC, the clinical symptoms that are most associated with CC, and the subsequent care management for patients presenting with suspected cord compression who received the survey spine MR imaging may better inform the broad adoption and subsequent utilization of survey imaging protocols in emergency settings to increase throughput, improve allocation of resources, and provide efficient care for patients with suspected CC.
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Affiliation(s)
- Mercy H Mazurek
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Annie R Abruzzo
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Alexander H King
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Erica Koranteng
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Grant Rigney
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Winston Lie
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Shahaan Razak
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Rajiv Gupta
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
- Department of Radiology (R.G., W.A.M., M.H.L., J.A.H., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - William A Mehan
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
- Department of Radiology (R.G., W.A.M., M.H.L., J.A.H., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Michael H Lev
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
- Department of Radiology (R.G., W.A.M., M.H.L., J.A.H., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Joshua A Hirsch
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
- Department of Radiology (R.G., W.A.M., M.H.L., J.A.H., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Karen Buch
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Marc D Succi
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
- Department of Radiology (R.G., W.A.M., M.H.L., J.A.H., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
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