L. Kuo1, B. Frank1, C. Sharoky1, D. Holena1 1University Of Pennsylvania,SURGERY,Philadelphia, PA, USA
Introduction: Diagnosis of cervical spine (c-spine) injuries requires a balance between resource use and diagnostic efficacy. In 2009, EAST published c-spine management guidelines but the impact remains of these recommendations is unknown. We hypothesized MRI use varies between institutions but that higher utilization does not correlate with higher rates of c-spine injury diagnosis. We also sought to characterize variability in MRI charges between institutions.
Methods: We performed a retrospective review of blunt injury patients aged 18-65 years at level I & II trauma centers in Pennsylvania from 2011-2014. Transferred patients were excluded. Center-level variation in cervical spine MRI use in patients with c-spine injury was calculated, as was cost difference between high and low utilization centers. MRI and c-spine injuries were derived from ICD-9-CM codes and stratified by Glascow Coma Score (GSC) level (high, 14-15; low 3-13). Correlation between center rates of MRI use and c-spine injury. Annual c-spine MRI charge per center was calculated using average prices from 9 different MRI and CT centers around the country.
Results: 36,316 patients at 26 centers were included (median age 45 (IQR 29-55), 81% white, 67% male). 8,708 (23%) had c-spine injuries. Mean center cervical MRI rate was 12.8% (range: 1.2% – 26.9% )(Figure). In patients with c-spine injuries, MRI rates varied from 4.1% to 82.3%. In the high GCS subset, rates ranged from 1.5% to 26.7%. with no relation between MRI rates and c-spine injury (rho = 0.10, p = 0.61). Estimating an average charge of $1419/MRI, the highest use center had MRI charges of $1920/c-spine injury compared to $69/injury at the lowest use center
Conclusion: Despite 5 year-old guidelines, MRI utilization is highly variable and uncorrelated with rates of c-spine injury. In the current climate of high quality outcomes at lower cost, efforts to standardize care and reduce cost associated with the diagnosis of c-spine injuries should be pursued.
