Improving Effective Magnetic Resonance Imaging (MRI) Application in Soft Tissue Wrist Injury

Journal of the American Board of Family Medicine: JABFM

Helen E. Huetteman^1¹  Brett F. Michelotti^1²  Alexandra L. Mathews^1³  Alfred P. Yoon^1⁴ 

[1] Department of Surgery, Division of Plastic Surgery, University of Wisconsin Health System, Madison, WI (BFM);Section of Plastic Surgery, Assistant Dean for Faculty Affairs, The University of Michigan Medical School, Ann Arbor (KCC)^1;Stritch School of Medicine, Loyola University, Chicago, IL (ALM);From the Section of Plastic Surgery, Department of Surgery, The University of Michigan Medical School, Ann Arbor (APY, HEH)

关键词: Differential Diagnosis;    Magnetic Resonance Imaging;    Soft Tissue Injuries;    Surgeons;    Wrist Injuries;   

DOI  :  10.3122/jabfm.2018.05.170423

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Introduction: Magnetic resonance imaging (MRI) for soft-tissue wrist injury may be overprescribed, contributing to ineffective health care resource use. We aimed to discern predictive factors that may improve MRI's application in soft-tissue wrist injury. Methods: We conducted a retrospective chart review of adults who underwent MRIs for possible soft-tissue wrist injury between June 2009 and June 2014. Clinical data and treatment recommendations before and after MRI were analyzed. If the MRI-directed treatment recommendation was different from before MRI, the MRI was noted to have influenced the patient's treatment (Impact MRI). Results: Among 140 MRI scans, 39 (28%) impacted treatment recommendation. Twenty-six Impact MRIs were ordered by hand surgeons, whereas 13 were ordered by referring physicians ( P = .001). More Impact MRIs were found when an MRI was ordered for patients younger than 36 years ( P = .01), within 6 weeks of symptom onset ( P = .03), to question a specific anatomic injury ( P = .0001), or by a board-certified hand surgeon ( P = .001). Adjusting for other covariates, these 4 clinical factors were identified as independent predictive factors to Impact MRIs. Conclusions: MRIs for soft-tissue wrist injuries may more likely change management when the patient is younger, ordered within 6 weeks of symptom onset, and prescribed with a specific differential diagnosis. Referral to a hand surgeon should be considered before wrist MRI for the following patients: history of hand surgery/trauma, older than 36 years likely due to confounding chronic wrist changes, symptomatic for more than 6 weeks, and without clear differential diagnoses for the symptoms.

【 授权许可】

CC BY