General anesthesia / sedation requirement influences the way MRI brain scans are ordered in a tertiary pediatric hospital

Abstract

Background MRI guidelines have been created to help clinicians order scans appropriately. Some scans in children are carried out under general anesthesia (GA) / sedation. Purpose To evaluate if the requirement for GA/sedation influences the way MRI brain scans are ordered. Study Type Retrospective. Population Children with MRI brain scans in 2015 to 2017. Field Strength 3T, 1.5T. Assessment Institutional Review Board approval for waiver of consent was obtained. Clinical MRI brain reports for children were classified into whether they conformed to the American College of Radiology (ACR) 2013 guidelines by research assistants under supervision of a pediatric radiologist. Scans were sorted into those with normal brains or abnormality. Statistical Test The statistical difference between groups was assessed using t‐test for continuous variables and chi‐square test for categorical variables with IBM SPSS 19. Results Of the total 1893 MRI scans, 431 were performed under GA and six under sedation. Of the 431 cases performed under GA/sedation, 383 (87.6%) were ordered according to guidelines. Of the 1456 cases that did not require GA/sedation, 710 (48.8%) conformed to guidelines. The percentage of scans ordered according to guidelines was 38.8% higher in those who had scans performed under GA/sedation (P < 0.001). MRI scans were normal in 635 (58.0%) out of the 1093 cases ordered according to guidelines and normal in 638 (79.8%) out of the 800 cases that did not follow guidelines. Scans not ordered according to guidelines had higher proportion of normal scans (21.8%) compared with those ordered according to guidelines (P < 0.001). Data Conclusion Higher adherence to imaging guidelines is seen in younger patients who were exposed to the risks of GA/sedation for the MRI. Scans not adhering to guidelines had a higher percentage of having no brain abnormality detected. Level of Evidence: 3 Technical Efficacy: Stage 6 J. Magn. Reson. Imaging 2019;49:e250–e255.

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“…Interestingly, the proportion of children aged 3–7 years who did the scan under GA is lower in the current study as compared to the study by Ong et al . [ 2 ] This could be due to increased awareness of staff on which children would be able to tolerate an MRI scan without GA.[ 16 ] In addition, a few parents in this study had requested the anaesthesiologist to let their children try the scan without GA, thus lowering the incidence of GA in the current population. Although we have not explored the parents’ intentions for attempting the scan without GA for their children, these parents could be more aware of and educated about the risks associated with GA.…”