The Implications of Delayed access to MRI Imaging: a 3 month historical prospective study

Dear Sir,

MRI is a crucial imaging modality utilized frequently used in the orthopaedic setting, and is particularly useful in the paediatric population who benefit from a radiation-free investigation. Delays in access to MRI imaging and reporting can lead to delayed diagnosis, hindered appropriate treatment or development of complications.

With this in mind, we performed a historical prospective audit to assess the delay in accessing and reporting of MRIs for orthopaedic paediatric in-patients at our institution, over a three month period from 1st January 2015 until 31st March 2015.

Twenty-five patients were included in the study. In total, 28 requests for MRI were made. Sixty-one percent of patients were male. All patients had previous x-ray imaging. Forty-six percent (n=13) underwent other additional imaging modalities prior to MRI including; ultrasound (62%, n=8), CT (15%, n=2), previous MRI (23%, n=3). Primary indications for MRI included; to diagnose or exclude osteomyelitis (55%), to aid diagnosis or alleviate concern of malignancy from prior imaging (19%), to diagnose soft tissue pathology (19%), to out-rule organic pathology for relapsing remitting pain with unremarkable investigations to date (7%). Mean delay in access to MRI was 4.5 days, range 0-15. 93% of MRIs were performed with an interval of greater than 24 hours from time of request. Delays in access to MRI correlated with delayed discharges (p<0.001). All MRIs were reported in less than 24 hours, 50% of which were within 1 hour.

Over half of patients (56%) had a delayed discharge as a result of delayed access to MRI, resulting in 62 additional bed days to the hospital. Eleven patients were treated “unnecessarily” but appropriately with empirical antibiotic therapy for suspected osteomyelitis until they underwent MRI imaging. One patient developed conus medullaris awaiting MRI and required emergent surgery. Delays in access to MRI can inevitably result in adverse consequences for both the patient and hospital resources. In a tertiary setting, consideration should be given to optimal utilization of the MRI asset including extending its operating hours, increasing resources to radiographers and ring-fencing for potentially serious conditions.

A Daly, A Hoban, C Egan, D Moore, P Kiely

Correspondence: Adam Daly, Orthopaedic Department, Our Ladies Children’s Hospital, Crumlin, Dublin 12

Email: [email protected]