Implementation of a Magnetic Resonance Imaging scanner dedicated to emergencies in cases of binocular diplopia: Impact on patient management - 26/04/21

Doi : 10.1016/j.neurad.2021.03.008

Marie Stoessel ^a,^⁎ , François Lersy ^a , Mylène Moris ^b , Guillaume Bierry ^a , Mathieu Anheim ^c , Stéphane Kremer ^a , Sabrina Garnier-Kepka ^b
^a Service de Radiologie 2, Hôpitaux Universitaires de Strasbourg – Hautepierre, 1, Avenue Molière, 67098 Strasbourg, France
^b Service des Urgences, Hôpitaux Universitaires de Strasbourg, 1, Place de l’Hôpital, 67000 Strasbourg, France
^c Service de Neurologie, Hôpitaux Universitaires de Strasbourg – Hautepierre, 1, Avenue Molière, 67098 Strasbourg, France

^⁎Corresponding author at: 4 quai Mathiss, 67000 Strasbourg, France.4 quai MathissStrasbourg67000France

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Monday 26 April 2021
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Graphical abstract

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Highlights

•	Significant difference in examination modalities (more patients in the MRI group had an image-based diagnosis explaining their symptomatology than in the CT group), with no effect of gender, age or duration of disease.
•	Performing an MRI scan as a first-line procedure does not increase average turnaround time or emergency department length of stay.
•	No significant difference in hospitalization rates or hospital length of stay between the two groups.
•	Performing an MRI scan as a first-line procedure reduces patient's exposure to ionizing radiation.

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Abstract

Rationale and objectives

Evaluate the implementation of an MRI scanner dedicated to emergencies on the management of patients admitted in the emergency department (ED) for binocular diplopia (BD).

Material and methods

This was a prospective non-interventional single-center study from February 2018 to February 2020. A total of 110 patients were included: 52 patients during the first stage (29 women; 23 men; mean age 65.2 years); 58 during the second stage (29 women; 29 men; mean age 51.4 years). Patients underwent an enhanced-CT examination in the first stage and an MRI examination in the second stage. Criteria used to evaluate the new management of patients were: proportion of patients with an imaging diagnosis explaining BD, turnaround time (TT), ED length of stay (EDLOS), hospital admission rate, hospital length of stay (HLOS), number of MRI examinations requested as a second procedure for the same indication and radiation doses. Descriptive statistics were used to present results with Student's test for quantitative variables and chi-square test for qualitative variables.

Results

Respectively 1 (1.92%) and 17 (29.31%) patients had definitive diagnosis in stages 1 and 2, with a significant difference in examination modalities (p=0.0001). The TT, EDLOS, hospital admission rate, and HLOS were not significantly different between the two stages. Radiation dose was significantly different between the two groups (p<0.05).

Conclusion

Implementation of an MRI scanner dedicated to emergencies can improve the etiological diagnostic performance of binocular diplopia and reduce patient's exposure to ionizing radiation without increasing the average turnaround time or emergency department length of stay.

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Abbreviations : BD, CTA, ED, EDLOS, HLOS, IS, TT

Keywords : Diplopia, Emergency service, Magnetic Resonance Imaging, Length of stay, Radiation dosage