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Authors Michelotti BF, Mathews A, Chung KC
Author Profile(s)
Journal Plast. Reconstr. Surg.
Publish Date 2017 Oct 12
PubMed ID 29036028
Abstract

When diagnosing wrist ligamentous injury, we hypothesize that MRI is used injudiciously and is associated with unnecessary cost.A retrospective review was conducted of patients, ages 20-60 years, who underwent an MRI for possible wrist ligamentous injury at a tertiary care center between 2009 and 2014. Treatment recommendation was classified as non-operative, operative, or equivocal. If the MRI-directed treatment recommendation differed from the pre-MRI treatment recommendation, we noted that the MRI influenced patient care (impact study). The cost estimate of an impact study was calculated by dividing the total studies performed by the number of studies that impacted the treatment recommendation and multiplying this value by the institutional wrist MRI cost (USD $2,246, 2016).140 patients were included. MRI affected treatment recommendation in 28% of patients. Independent predictors of MRI impact on treatment recommendation were: “question specific injury,” or “question scapholunate injury.” (OR 9.46 (3.18 – 28.16), P<0.001), OR 2.88(1.21-6.88), P=0.02). The only independent predictor of surgery was ordering physician (hand surgeon) (OR 3.69 (1.34-10.13), P=0.01). The cost of an impact study ordered by a non-hand surgeon vs. hand surgeon was $13,359 versus $6,491.The provider must carefully consider the pre-test probability of ordering a study that will affect treatment recommendation. Injudicious screening with MRI ($15,565) incurred a cost nearly seven times the cost of the one MRI ($2,246) before impacting one treatment recommendation. In the current era of cost containment and bundled payment, diagnostic test probability must be appreciated to guide physician ordering practices.

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