Improving the ED: a Rapid MRI Protocol

Posted on April 2016

More than 250,000 elderly are hospitalized for hip fractures every year, an injury that often has a lasting negative impact on an individual’s independence. Over 30% of people with a hip fracture will die in the following year, and even more will have significant functional loss, according to a University of Calgary study. To make a bad situation worse, hip fractures are expensive: a patient in the U.S. spends an average of $40,000 on treatment during the first year after the injury. However, UW Radiology Fellow Drew Ross, M.D., and Associate Professor Kenneth Lee, M.D., believe that an under-utilized MRI technique may hold the key to saving these patients time, money, and pain. Their study proposal was the recipient of a Society of Skeletal Radiology (SSR) Seed Grant, and Dr. Ross will present his findings at the SSR 2017 Annual Meeting.

Nearly all of these fractures are caused by falls and can present diagnostic challenges once the patient arrives at the emergency department. The standard first line imaging procedure for a suspected hip fracture is a radiograph, but the exam has a false negative rate of at least 20% for hip fractures. A standard MRI exam can be more precise, but is also more expensive and time consuming. Rather, Dr. Ross posits that a rapid MRI protocol for high-risk patients can provide the necessary diagnostic information while remaining cost- and time-effective.

The initial phase of the study will be retrospective, comparing the shortened exam to the full MRI protocol. Once the effectiveness of the scan is established, Dr. Ross and his colleagues will refine the exam, making it more precise and rapid for the hip. The second part of the study is a quantitative cost analysis to demonstrate the savings the exam could bring to care centers.

“Quickly identifying a fracture can save time and money,” said Dr. Ross. If left undiagnosed the fracture can worsen, even in the hospital. The treatment for a Stage One fracture is three screws but the treatment for a Stage Three fracture is a full hip replacement, a much more complicated and expensive procedure. For some patients, the rapid MRI protocol could rule out a hip fracture, paving the way for a discharge from the hospital. “It’s about getting the patient the correct level of care rapidly and with a high level of confidence,” said Dr. Ross.