Rapid MRI for Stroke Patients in ED Reduces Health Care Costs

According to science presented at the AAN 2020 Annual Meeting, rapid MRI is a cost-effective diagnosis method in the emergency department evaluation of suspected stroke patients. 

Adam de Havenon, MD, University of Utah, and colleagues, explained that short duration or rapid MRI protocols have grown increasingly common for evaluation of ischemic stroke, but there is limited data on the cost-effectiveness. 

The study consisted of patients who presented to the emergency department with what the researchers describe as “brain attack” codes and were also suspected of having acute stroke. 

“We included sequential patients who had CT perfusion (CTP) as part of their acute stroke evaluation from the years before rapid MRI was available and compared them to patients who had an 8-minute rapid MRI for acute stroke evaluation.” This included 467 patient encounters which were used to assess differences between MRI (n=168) and CTP (n=299). 

Patient subjects were categorized using propensity score matching to balance patient age, race, NIH Stroke Scale, and final diagnosis (stroke vs mimic). The final matched cohort included 164 MRI and 115 CTP patients. The researchers evaluated the differences in log-scale cost of patient care to their health care system and the length of stay with average treatment effect for the treated (ATET), a robust methodology to account for possible confounders.

Results of the study using propensity score Kernel matching found significant decreases in the MRI group for::

• total cost [ATET, -0.550; 95% CI (-0.952, -0.149)]; 
• pharmacy [ATET, -1.085; 95% CI (-2.010, -0.160)]; and 
• supplies [ATET, -0.196; 95% CI (-0.909, 0.518)].

The researchers observed a marginally significant decrease in length of stay days [ATET, -0.712; 95% CI (-1.49, 0.064)] in the MRI group.

“Because our cohort was matched on potential confounders, such as stroke severity and final diagnosis, these results provide compelling evidence that emergency department utilization of rapid MRI is cost-effective.” —Edan Stanley