Aryan Jalilvand1, George Velmahos2, Christopher Baugh3, Andrew Schoenfeld4, Mitchel Harris5, Bharti Khurana6. 1. Department of Radiology, Brigham and Women's Hospital, MA, Boston, USA. ajalilvand@bwh.harvard.edu. 2. Department of Surgery, Massachusettes General Hospital, MA, Boston, USA. 3. Department of Emergency Medicine Brigham and Women's Hospital , MA, Boston, USA. 4. Department of Orthopedic Surgery Brigham and Women's Hospital, MA, Boston, USA. 5. Department of Orthopedic Surgery, Massachusetts General Hospital, MA, Boston, USA. 6. Trauma Imaging Research and Innovation Center Brigham and Women's Hospital Department of Radiology Brigham and Women's Hospital, MA, Boston, USA.
Abstract
PURPOSE: To describe the clinical presentation of trauma patients receiving a negative cervical spine MRI (CSMRI) after cervical spine CT (CSCT) without acute findings and calculate the associated costs. METHODS: Our cohort consisted of 55 retrospectively reviewed consecutive trauma patients with CSMRI performed between October 2016 and March 2020, who had negative CSCT within 7 days of CSMRI and no other clinically significant injuries. Our outcome was the cost related to CSMRI, estimated by CSMRI charges and the charges related to additional hours of prolonged hospital stay from CT until MRI. RESULTS: The most common presenting mechanisms of injury were fall from standing (20/55, 36%), followed by motor vehicle accident (18, 33%). Indications for CSMRI included persistent neck pain (32/55, 58%), followed by recommendation from the radiologist (12, 22%), and neurological symptoms concerning for spine injury (9, 16%). An average of 11.2 h (median: 8.5, range: 0.2-25.4 h) passed from CSCT to CSMRI. Fifty-four (98%) of the CSMRI exams were completed within 24 h of the CSCT. The Medicare reimbursement for non-contrast CSMRI is $309 with the average cost for waiting in ED observation of $907. The total cost of CSMRI and associated wait time ranged from $325 to $2366 with an average of $1216 per patient. CONCLUSIONS: The cost of negative CSMRI following a negative CSCT for cervical spine clearance in trauma patients without other significant injury is substantial. The length of time that trauma patients remain in observation in the cervical collar prior to the finalized MRI exam is not only distressing to the patient but also adds costs to health care systems in both time and resources.
PURPOSE: To describe the clinical presentation of traumapatients receiving a negative cervical spine MRI (CSMRI) after cervical spine CT (CSCT) without acute findings and calculate the associated costs. METHODS: Our cohort consisted of 55 retrospectively reviewed consecutive traumapatients with CSMRI performed between October 2016 and March 2020, who had negative CSCT within 7 days of CSMRI and no other clinically significant injuries. Our outcome was the cost related to CSMRI, estimated by CSMRI charges and the charges related to additional hours of prolonged hospital stay from CT until MRI. RESULTS: The most common presenting mechanisms of injury were fall from standing (20/55, 36%), followed by motor vehicle accident (18, 33%). Indications for CSMRI included persistent neck pain (32/55, 58%), followed by recommendation from the radiologist (12, 22%), and neurological symptoms concerning for spine injury (9, 16%). An average of 11.2 h (median: 8.5, range: 0.2-25.4 h) passed from CSCT to CSMRI. Fifty-four (98%) of the CSMRI exams were completed within 24 h of the CSCT. The Medicare reimbursement for non-contrast CSMRI is $309 with the average cost for waiting in ED observation of $907. The total cost of CSMRI and associated wait time ranged from $325 to $2366 with an average of $1216 per patient. CONCLUSIONS: The cost of negative CSMRI following a negative CSCT for cervical spine clearance in traumapatients without other significant injury is substantial. The length of time that traumapatients remain in observation in the cervical collar prior to the finalized MRI exam is not only distressing to the patient but also adds costs to health care systems in both time and resources.
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