BACKGROUND Rapid magnetic resonance imaging (MRI) protocols may be effective in the emergency department (ED) to evaluate nontraumatic neurologic complaints. We evaluate neuroimaging (rapid MRI [rMRI]), head computerized tomography [HCT], and full MRI) use following widespread implementation of rMRI protocols in a pediatric emergency department (ED). METHODS We conducted a retrospective study in a tertiary care pediatric ED of encounters with neuroimaging during two 9-month periods: one prior to (control period) and one after generalized availability of 4 rMRI protocols (rMRI period). The primary outcome was differences in neuroimaging rates between the two periods. Secondary outcomes included ED process measures, unsuccessful imaging, and undetected pathology, with full MRI within 14 days as the reference standard. RESULTS There were 1052 encounters with neuroimaging during the control and 1308 during the rMRI periods. Differences in neuroimaging between periods were 27.7% for rMRI (95% CI, 24.4, 31.0), - 21.5% for HCT (95% CI, - 25.5, - 17.5), and - 6.2% for full MRI (95% CI, - 9.3, - 3.1%.) Time to imaging (182 [IQR 138-255] versus 86 [IQR 52-137] minutes) as well as ED length of stay (396 [IQR 304-484] versus 257 [IQR 196-334] minutes) was longer for rMRI versus HCT (p < 0.01). Between the control and rMRI periods, there were differences in types of neuroimaging performed for patients with altered mental status, headache, seizure, shunt dysfunction, stroke, syncope, trauma, vomiting, infection, and other neurologic complaints (p < 0.05). rMRI studies were unsuccessful in 3.6% of studies versus 0.0% of HCTs (p < 0.01). The 22 unsuccessful rMRI studies were unsuccessful due to artifacts from dental hardware (n = 2) and patient motion (n = 20). None of the rMRI studies with full MRI follow-up imaging had undetected pathology; the false negative rate for the HCT exams was as high as 25%. CONCLUSIONS After routine ED use of 4 rMRI protocols, there was a more than 20% decrease in HCT use without missed diagnoses. Time to neuroimaging and length of stay were longer for rMRI than HCT, with higher rates of unsuccessful imaging. Despite these limitations, rMRI may be an alternative to HCT for nontraumatic complaints in the ED.

中文翻译：

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快速的脑部MRI协议减少了儿科急诊科的头部计算机断层扫描。

背景技术快速磁共振成像（MRI）协议在急诊科（ED）中可以有效地评估非创伤性神经系统疾病。在儿科急诊科（ED）广泛实施rMRI协议后，我们评估了神经成像（快速MRI [rMRI]），头部计算机断层扫描[HCT]和完整MRI）的使用情况。方法我们对三级神经影像学检查的三级儿科ED进行了一项回顾性研究，该研究在两个9个月期间进行：一个在（对照期之前），另一个在4种rMRI方案（rMRI时期）普遍可用之后。主要结果是两个时期之间的神经影像学率差异。次要结果包括ED过程测量，成像失败和病理未检出，以14天之内的完整MRI作为参考标准。结果在对照中有1052次神经影像学检查，在rMRI期间有1308次神经影像学检查。rMRI（95％CI，24.4，31.0）在两个时期之间的神经影像学差异为27.7％，HCT（95％CI，-25.5，-17.5）--21.5％，完整MRI（95％CI，-- 9.3，-3.1％。）成像时间（182 [IQR 138-255]对86 [IQR 52-137]分钟）以及ED住院时间（396 [IQR 304-484]对257 [IQR 196-334] rMRI相对于HCT较长[]分钟]（p <0.01）。在对照和rMRI期间，对于精神状态改变，头痛，癫痫发作，分流功能障碍，中风，晕厥，外伤，呕吐，感染和其他神经系统疾病的患者，进行的神经影像学检查类型存在差异（p <0.05）。3.6％的研究未进行rMRI研究，而HCT的0.0％进行了rMRI研究（p <0.01）。由于牙齿硬件（n = 2）和患者运动（n = 20）造成的假象，22项rMRI研究失败。完整的MRI追踪成像的rMRI研究均未发现病理学异常；HCT考试的假阴性率高达25％。结论常规ED使用4种rMRI方案后，HCT的使用减少了20％以上，而没有漏诊。与HCT相比，rMRI的神经成像时间和住院时间更长，成像失败率更高。尽管存在这些局限性，但对于急诊科中的非创伤性主诉，rMRI仍可以替代HCT。结论常规ED使用4种rMRI方案后，HCT的使用减少了20％以上，而没有漏诊。与HCT相比，rMRI的神经成像时间和住院时间更长，成像失败率更高。尽管存在这些局限性，但对于急诊科中的非创伤性主诉，rMRI仍可以替代HCT。结论常规ED使用4种rMRI方案后，HCT的使用减少了20％以上，而没有漏诊。与HCT相比，rMRI的神经成像时间和住院时间更长，成像失败率更高。尽管存在这些局限性，但对于急诊科中的非创伤性主诉，rMRI仍可以替代HCT。