USA: The use of a rapid MRI protocol in the emergency department (ED) in people suspected of acute ischemic stroke was tied to a 17% reduction in hospital length of stay and a 18.7% reduction in total direct cost, shows a recent study in The Neuroradiology Journal. The researchers however states these results to be preliminary and hypothesis-generating.
Abbreviated "rapid MRI" protocols have become more usual for the evaluation of acute ischemic stroke (AIS). No previous study has evaluated the effect of rapid MRIs on cost or hospital length of stay in AIS patients. To fill this knowledge gap, Adam de Havenon, Department of Neurology, Yale University, New Haven, CT, USA, and colleagues conducted a study that included 408 patients who presented in the ED for suspected stroke.

They retrospectively identified AIS patients who presented within 6 h of acute neurologic symptom onset to an ED and activated a "brain attack" code. Sequential patients from January 2012 to September 2015 were included, before rapid MRI was available, who had CT perfusion (CTP). These patients were compared with patients from October 2015 to May 2018 who had a rapid MRI.
Inverse-probability-weighting (IPW) was used to balance the cohorts. Direct cost to healthcare system and total hospital length of stay (LOS) were the primary outcomes.
The findings of the study were as follows:
· 408 brain attack activations (mean ± SD age 62.1 ± 17.6 years, 47.8% male) were included: 257 in the CTP cohort and 151 in the MRI cohort.
· Discharge diagnosis was ischemic stroke in 193/408 (47.3%).
· After patient matching, significant reductions were found for the MRI cohort in total cost (−18.7%) and hospital LOS (−17.0%), with no difference in ED LOS as compared to the CTP cohort.
The authors conclude, "although these results are preliminary and hypothesis-generating, we found that the rapid MRI protocol use in ED brain attacks was associated with a 18.7% reduction in total direct cost and 17% reduction in hospital length of stay."
Reference:
de Havenon A, Orlando C, Delic A, et al. Direct cost analysis of rapid MRI in the emergency department evaluation of patients suspected of having acute ischemic stroke. The Neuroradiology Journal. June 2022. doi:10.1177/19714009221108681