Real-World Rapid Brain Magnetic Resonance Imaging Utilization in the Pediatric Emergency Setting: A 10-Year Cross-Sectional Study.

OBJECTIVES

Rapid brain MRI (rMRI) provides a radiation-free neuroimaging tool to screen children without sedation. Our objective was to retrospectively analyze clinical rMRI utilization by describing demographics, operational metrics, clinical indications, and temporal trends associated with rMRI utilization in the emergency department (ED).

METHODS

We conducted a single-center, retrospective, cross-sectional study of children who underwent rMRI in the ED at an urban children's hospital between May 2014 and March 2024. We used descriptive statistics to examine operational metrics and trends in rMRI utilization over the study period. We performed a subgroup analysis of operational metrics by age and clinical indication.

RESULTS

We included 2401 patients who underwent rMRI during their ED encounter. rMRI was frequently performed in infants and toddlers younger than 3 years old (n = 604, 25.1%), with a median patient age of 8.0 [interquartile range (IQR): 3.0 to 14.5] years. The median (IQR) time to scan was 3.5 (2.4 to 5.1) hours, and the median (IQR) ED length of stay was 7.5 (5.8 to 9.6) hours. Of the total, 1917 (79.8%) patients were initially triaged as "emergent," and 990 (41.2%) were discharged home from the ED. rMRI was predominantly used to evaluate ventricular shunt function (n = 2069, 86.1%) and traumatic brain injury (n = 214, 9.0%). Annual rMRI utilization increased by 80.8% between 2015 and 2023, with an average utilization rate increase of 46.1 scans annually between the years 2015 and 2019, and relatively static utilization rate from 2020 to 2023.

CONCLUSIONS

This work supports the feasibility of widespread rMRI in the high-volume ED care setting, including for young children. rMRI utilization increased over time, with the technique most frequently used to evaluate ventricular shunt function and traumatic brain injury.