The impact of installing an MR scanner in the emergency department for patients presenting with acute stroke-like symptoms

• Published in: Clinical imaging 2017-09, Vol.45, p.65-70
• Main Authors: Honig, Stephanie E, Babiarz, Lukasz B, Honig, Evan L, Mirbagheri, Saeedeh, Urrutia, Victor, Yousem, David M
• Format: Article
• Language: English
• Subjects: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Cerebrovascular disorders; Child; Diagnosis; Discharge; Emergency department; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Equipment and Supplies, Hospital - supply & distribution; Female; Humans; Imaging; Ischemia; Magnetic resonance imaging; Magnetic Resonance Imaging - instrumentation; Magnetic Resonance Imaging - utilization; Male; Medical imaging; Middle Aged; Neurology; NMR; Nuclear magnetic resonance; Patients; Radiology; Retrospective Studies; Scanners; Stroke; Stroke - diagnosis; Transient ischemic attack; Young Adult; Young adults
• ISSN: 0899-7071; 1873-4499
• DOI: 10.1016/j.clinimag.2017.05.015

Abstract Purpose We examined the impact of an MR scanner in the emergency department (ED) on ED length of stay (LOS), hospital (H) LOS, hospital admission rate, hospitalization costs, and ED re-presentation rate of patients presenting with stroke-like symptoms (SLS). We hypothesized that the ED MR would increase efficiency of patient care. Methods The number of MRIs performed in the ED vs. inpatient setting, EDLOS, HLOS, hospitalization charges, admission rate, discharge diagnoses, and 30–60-day ED re-presentation rates were determined for ED patients with SLS six months before (2011) and after (2012) ED MR installation. Results 362 and 448 patients with SLS presented to the ED, and 196 and 176 patients were admitted in 2011 and 2012 respectively. In 2011, 36 (18.4%) admitted patients, and, in 2012, 68 (38.6%) had MRIs in the ED, p < 0.001. In 2011, 74 (37.8%) admitted patients were diagnosed with ischemic stroke, compared to 92 (52.3%) in 2012, p = 0.007. HLOS was longer and charges higher for patients with stroke. No patients returned with a confirmed diagnosis of CVA or TIA within 0–60 days after being discharged from the ED with negative MR. Conclusions With the ED MR, more admitted patients 1) got scanned in the ED and 2) were diagnosed with stroke. Because this led to more patients on the stroke service actually suffering from strokes (and not other diagnoses), the overall HLOS and charges of patients presenting with SLS were not reduced by ED MR screening. Discharge after a negative ED MR did not incur risk of TIAs or strokes over the ensuing 60 days. Therefore, not only does a dedicated MR scanner in the ED aid in the acute diagnosis of a CVA or other neurologic disorder, but it does so without the risk of under-diagnosing TIAs or evolving strokes in the presence of a negative MRI.