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The impact of installing an MR scanner in the emergency department for patients presenting with acute stroke-like symptoms

  • Stephanie E. Honig
    Affiliations
    Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Baltimore, MD 21287, United States
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  • Lukasz S. Babiarz
    Affiliations
    Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Baltimore, MD 21287, United States
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  • Evan L. Honig
    Affiliations
    Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Baltimore, MD 21287, United States
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  • Saeedeh Mirbagheri
    Affiliations
    Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Baltimore, MD 21287, United States
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  • Victor Urrutia
    Affiliations
    Department of Neurology, The Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Baltimore, MD 21287, United States
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  • David M. Yousem
    Correspondence
    Corresponding author at: Johns Hopkins Medical Institutions, 600 N. Wolfe Street Phipps B100F, Baltimore MD 21287, United States.
    Affiliations
    Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Baltimore, MD 21287, United States
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      Highlights

      • After installation of the MR in the ED, there was increased use of the ED MR.
      • More patients admitted actually had a stroke, so LOS did not decrease.
      • Patients discharged after a negative MR were not at risk for stroke within 60 days.
      • ED MR yields improved efficiency and accuracy without under-diagnosing strokes.

      Abstract

      Purpose

      We examined the impact of an MR scanner in the emergency department (ED) on ED length of stay (LOS), hospital (H) LOS, hospital admission rate, hospitalization costs, and ED re-presentation rate of patients presenting with stroke-like symptoms (SLS). We hypothesized that the ED MR would increase efficiency of patient care.

      Methods

      The number of MRIs performed in the ED vs. inpatient setting, EDLOS, HLOS, hospitalization charges, admission rate, discharge diagnoses, and 30–60-day ED re-presentation rates were determined for ED patients with SLS six months before (2011) and after (2012) ED MR installation.

      Results

      362 and 448 patients with SLS presented to the ED, and 196 and 176 patients were admitted in 2011 and 2012 respectively. In 2011, 36 (18.4%) admitted patients, and, in 2012, 68 (38.6%) had MRIs in the ED, p < 0.001. In 2011, 74 (37.8%) admitted patients were diagnosed with ischemic stroke, compared to 92 (52.3%) in 2012, p = 0.007. HLOS was longer and charges higher for patients with stroke. No patients returned with a confirmed diagnosis of CVA or TIA within 0–60 days after being discharged from the ED with negative MR.

      Conclusions

      With the ED MR, more admitted patients 1) got scanned in the ED and 2) were diagnosed with stroke. Because this led to more patients on the stroke service actually suffering from strokes (and not other diagnoses), the overall HLOS and charges of patients presenting with SLS were not reduced by ED MR screening. Discharge after a negative ED MR did not incur risk of TIAs or strokes over the ensuing 60 days. Therefore, not only does a dedicated MR scanner in the ED aid in the acute diagnosis of a CVA or other neurologic disorder, but it does so without the risk of under-diagnosing TIAs or evolving strokes in the presence of a negative MRI.

      Keywords

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