385 - Use of Fast MRI for Pediatric Neurologic Emergencies

Neurologic emergencies are among the most common reasons for visiting the pediatric emergency department (PED). Early recognition and differentiation of true neurologic emergencies from imitators impacts disease course, progression, and length of stay. Many pediatric institutions now perform fast magnetic resonance imaging (MRI). This new sequencing allows rapid MRI imaging in the PED and could potentially replace use of traditional computerized tomography (CT) in some situations.

Objective:

We hypothesized that use of fast MRI for patient's presenting to the PED with new neurologic complaints would increase diagnostic accuracy without increasing PED length of stay.

Design/Methods:

Using retrospective case-control methodology, we compared children ages 0-17 years of age presenting to the PED with new neurologic complaints who received fast MRI as the first imaging technique (case/fast MRI group) to those receiving head CT first (control/CT group) from July 2016 to June 2021. Each case was matched to two controls. Patients were excluded if they had known trauma, metabolic disease, or ingestion. Our primary outcomes were missed diagnoses and PED length of stay. Missed diagnosis included any pathologic findings found on repeat imaging not initially identified. Length of stay was defined as total time in the PED. Wilcoxon rank sum tests, Fisher's exact tests, and two-proportion Z-tests were used to examine differences in distribution of continuous, categorical, and dichotomous variables across groups, respectively.

Results:

A total of 159 children met case eligibility criteria and were matched to 318 controls. Children receiving fast MRI first were older (fast MRI 12yrs vs. CT 6yrs P < 0.05). Notably, the fast MRI group had a higher proportion with vascular and migraine pathology while the CT group had a higher proportion with epilepsy and “other” diagnoses (P < 0.05). Rates of follow-up imaging were similar between groups (33% vs. 34%). The CT group had a higher rate of missed diagnoses (24% vs. 9%), while the fast MRI group had more follow-up imaging as a part of routine care (P < 0.05). Length of stay in the PED and admission rates were similar between the groups (5hrs vs. 5hrs and 52% vs. 55%). Hospital length of stay was comparable between the fast MRI and CT groups.

Conclusion(s):

Fast MRI is a relatively new MR protocol utilizing rapid and motion insensitive sequences to detect acute intracranial pathology. Using case-control methodology, we found that fast MRI was associated with improved diagnostic accuracy without increasing PED length of stay.