MRI dedicated to the emergency department for diplopia or dizziness: a cost-effectiveness analysis.
Cost-benefit analysis
Diplopia
Dizziness
Emergency Service, Hospital
Magnetic resonance imaging
Journal
European radiology
ISSN: 1432-1084
Titre abrégé: Eur Radiol
Pays: Germany
ID NLM: 9114774
Informations de publication
Date de publication:
Nov 2022
Nov 2022
Historique:
received:
27
10
2021
accepted:
03
04
2022
revised:
29
03
2022
pubmed:
14
5
2022
medline:
19
11
2022
entrez:
13
5
2022
Statut:
ppublish
Résumé
The purpose of this study was to compare the costs and organizational benefits of diagnostic workup without and with MRI dedicated to the ED. We conducted a prospective observational uncontrolled before-after study in one ED of a university hospital in France from July 1, 2018, and January 3, 2020. We included all consecutive patients presenting with dizziness or diplopia. The main outcomes were the clinical decision time of ED physicians and the total costs for each strategy. Outcomes were compared using propensity score with inverse probability weighting in the 2 arms and an incremental cost-effectiveness ratio (ICER) was calculated. Among the 199 patients during the "before" period (average age: 60.4 years ± 17.6): 112 men (57%), and 181 during the "after" period (average age, 54.8 years ± 18.5): 107 men (59%), the average costs were €2701 (95% CI 1918; 3704) and €2389 (95% CI: €1627; 3280) per patient, respectively. The average time to clinical decision was 9.8 h (95% CI: 8.9 10.7) in the group "before" and 7.7 h (95% CI: 7.1; 8.4) in the group "after" (ICER: €151 saved for a reduction of 1 h in clinical decision time). The probabilistic sensitivity analysis estimated a 71% chance that the MRI dedicated to ED was dominant (less costly and more effective). Easy access to MRI in the ED for posterior circulation stroke-like symptoms must be considered a relevant approach to help physicians for an appropriate and rapid diagnostic with reduction of costs. NCT03660852 KEY POINTS: • A dedicated MRI in the ED for diplopia or dizziness may be considered an efficient strategy improving diagnostic performance, reducing physicians' decision time, and decreasing hospital costs. • This strategy supports clinical decision-making with early treatment and management of patients with posterior circulation-like symptoms in the ED. • There is 71% chance that the MRI dedicated to ED was dominant (less costly and more effective) compared with a strategy without dedicated MRI.
Identifiants
pubmed: 35554653
doi: 10.1007/s00330-022-08791-7
pii: 10.1007/s00330-022-08791-7
doi:
Banques de données
ClinicalTrials.gov
['NCT03660852']
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
7344-7353Informations de copyright
© 2022. The Author(s), under exclusive licence to European Society of Radiology.
Références
Tarnutzer AA, Berkowitz AL, Robinson KA, Hsieh YH, Newman-Toker DE (2011) Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ 183:571–592
doi: 10.1503/cmaj.100174
Fisher CM (1967) Vertigo in cerebrovascular disease. Arch Otolaryngol 85:529–534
doi: 10.1001/archotol.1967.00760040531010
Edlow JA, Newman-Toker DE, Savitz SI (2008) Diagnosis and initial management of cerebellar infarction. Lancet Neurol 7:951–964
doi: 10.1016/S1474-4422(08)70216-3
Shake A, Oostema A, Jones J (2018) BET 2: missed diagnosis of ischemic stroke in the emergency department. Emerg Med J 35:768–769
Edlow JA, Newman-Toker DE, Savitz SI (2008) Diagnosis and initial management of cerebellar infarction. Lancet Neurol 7:951–964
doi: 10.1016/S1474-4422(08)70216-3
Savitz SI, Caplan LR, Edlow JA (2007) Pitfalls in the diagnosis of cerebellar infarction. Acad Emerg Med 14:63–68
doi: 10.1197/j.aem.2006.06.060
Tohgi H, Takahashi S, Chiba K, Hirata Y (1993) Cerebellar Infarction Study Group Cerebellar infarction. Clinical and neuroimaging analysis in 293 patients. Stroke 24:1697–1701
doi: 10.1161/01.STR.24.11.1697
Newman-Toker DE, Hsieh YH, Camargo CA Jr, Pelletier AJ, Butchy GT (2008) Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc 83:765–775
doi: 10.4065/83.7.765
Kontorinis G (2018) The imaging of the dizzy patient: computed tomography versus magnetic resonance imaging. Eur Radiol 28:2914–2915
doi: 10.1007/s00330-018-5375-5
Ljunggren M, Persson J, Salzer J (2017) Dizziness and the acute vestibular syndrome at the emergency department: a population-based descriptive study. Eur Neurol 79:5–12
doi: 10.1159/000481982
Saber Tehrani AS, Coughlan D, Hsieh YH et al (2013) Rising annual costs of dizziness presentations to U.S. emergency departments. Acad Emerg Med 20:689–696
doi: 10.1111/acem.12168
De Lott LB, Kerber KA, Lee PP, Brown DL, Burke JF (2017) Diplopia-related ambulatory and emergency department visits in the united states, 2003-2012. JAMA Ophtalmol 135:1339–1344
doi: 10.1001/jamaophthalmol.2017.4508
Redd V, Levin S, Toerper M, Creel A, Peterson S (2015) Effects of fully accessible magnetic resonance imaging in the emergency department. Acad Emerg Med 22:741–749
doi: 10.1111/acem.12686
Honig SE, Babiarz LS, Honig EL, Mirbagheri S, Urrutia V, Yousem DM (2017) The impact of installing an MR scanner in the emergency department for patients presenting with acute stroke-like symptoms. Clin Imaging 45:65–70
doi: 10.1016/j.clinimag.2017.05.015
Buller M, Karis JP (2017) Introduction of a dedicated emergency department MR imaging scanner at the barrow neurological institute. AJNR Am J Neuroradiol 38:1480–1485
doi: 10.3174/ajnr.A5210
Ahsan SF, Syamal MN, Yaremchuk K, Peterson E, Seidman M (2013) The costs and utility of imaging in evaluating dizzy patients in the emergency room. Laryngoscope 123:2250–2253
doi: 10.1002/lary.23798
Chalela JA, Kidwell CS, Nentwich LM et al (2007) Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet 369:293–298
doi: 10.1016/S0140-6736(07)60151-2
Mullins ME, Schaefer PW, Sorensen AG et al (2002) CT and conventional and diffusion-weighted MR imaging in acute stroke: study in 691 patients at presentation to the emergency department. Radiology 224:353–360
doi: 10.1148/radiol.2242010873
Kabra R, Robbie H, Connor SE (2015) Diagnostic yield and impact of MRI for acute ischemic stroke in patients presenting with dizziness and vertigo. Clin Radiol 70:736–742
doi: 10.1016/j.crad.2015.01.016
Marin JR, Mills AM (2015) Developing a research agenda to optimize diagnostic imaging in the emergency department: an executive summary of the 2015 Academic Emergency Medicine Consensus Conference. Acad Emerg Med 22:1363–1371
doi: 10.1111/acem.12818
Puhr-Westerheide D, Froelich MF, Solyanik O et al (2021) Cost-effectiveness of short-protocol emergency brain MRI after negative non-contrast CT for minor stroke detection. Eur Radiol. https://doi.org/10.1007/s00330-021-08222-z
Husereau D, Drummond M, Petrou S et al (2013) ISPOR Health Economic Evaluation Publication Guidelines-CHEERS Good Reporting Practices Task Force. Consolidated Health Economic Evaluation Reporting Standards (CHEERS)--explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health 16:231–250
doi: 10.1016/j.jval.2013.02.002
Référentiel de coûts MCO 2018 (2018) Available via http://www.scansante.fr/r%C3%A9f%C3%A9rentiel-de-co%C3%BBts-mco-2018 . Accessed 30 June 2021
ATIH (2021) Tarifs MCO et HAD. Available via http://www.atih.sante.fr/tarifs-mco-et-had . Accessed 30 June 2021
ATIH (2021) Tarification de référence. Available via http://www.atih.sante.fr/tarification-de-reference . Accessed 30 June 2021
Venkat A, Cappelen-Smith C, Askar S et al (2018) Factors associated with stroke misdiagnosis in the emergency department: a retrospective case-control study. Neuroepidemiology 51:123–127
doi: 10.1159/000491635
Burns JD, Rindler RS, Carr C et al (2016) Delay in diagnosis of basilar artery stroke. Neurocrit Care 24:172–179
doi: 10.1007/s12028-015-0211-0
SFMU (2019) La hausse des passages aux urgences a ralenti en 2019. Available via https://www.sfmu.org/fr/actualites/actualites-de-l-urgences/la-hausse-des-passages-aux-urgences-a-ralenti-en-2019-analyse-apmnews-/new_id/66734 . Accessed 30 June 2021
Dang W, Kielar AZ, Fu AY, Chong ST, McInnes MD (2015) Does distance matter? Effect of having a dedicated CT scanner in the emergency department on completion of CT imaging and final patient disposition times. J Am Coll Radiol 12:277–283
doi: 10.1016/j.jacr.2014.11.003
Girot M, Marc JB, Wiel E et al (2017) Impact on patient management of the implementation of a magnetic resonance imaging dedicated to neurological emergencies. J Eval Clin Pract 23:1180–1186
doi: 10.1111/jep.12758
Machner B, Choi JH, Trillenberg P, Heide W, Helmchen C (2020) Risk of acute brain lesions in dizzy patients presenting to the emergency room: who needs imaging and who does not? J Neurol 267:126–135
doi: 10.1007/s00415-020-09909-x
Tarnutzer AA, Berkowitz AL, Robinson KA, Hsieh YH, Newman-Toker DE (2011) Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ 183(9):E571–E592
doi: 10.1503/cmaj.100174
Newman-Toker DE, Kerber KA, Hsieh YH et al (2013) HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness. Acad Emerg Med 20(10):986–996
doi: 10.1111/acem.12223
Krishnan K, Bassilious K, Eriksen E et al (2019) Posterior circulation stroke diagnosis using HINTS in patients presenting with acute vestibular syndrome: a systematic review. Eur Stroke J 4(3):233–239
doi: 10.1177/2396987319843701