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MRI follow-up after cervical spine trauma yielded lower health benefit, higher cost
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A cost-effectiveness analysis showed a lower health benefit and higher cost when MRI was used after a normal finding for spine instability on CT scan in patients with obtunded, blunt cervical spine trauma compared with no follow-up.
Using a Markov decision model during a lifetime horizon from a societal perspective, researchers evaluated an average patient aged 40 years with obtunded blunt trauma with variables from systematic reviews and meta-analyses and reimbursement rates from CMS, National Spinal Cord Injury Database and other large published studies. Researchers compared no follow-up vs. MRI follow-up after a normal cervical CT finding and collected data from the most recent literature available.
After a normal cervical finding in a 40-year-old patient with obtunded blunt trauma, results showed no follow-up to be the dominant strategy with a cost of $1,059 and a health benefit of 24.11 quality-adjusted life-years vs. a cost of $14,185 with a health benefit of 24.02 quality-adjusted life-years for MRI follow-up. In all 10,000 iterations, no follow-up was the better strategy, according to results of a probabilistic sensitivity analysis. Researchers found no follow-up as the better strategy when patients had a negative predictive value of greater than 98% on the initial CT. When the risk of an injury treated with a cervical collar turning into a permanent neurologic deficit was greater than 25% or when the risk of a missed injury turning into a neurologic deficit was less than 58%, no follow-up was also the better strategy, according to results. After simultaneous variation of the sensitivity and specificity of MRI in a two-way sensitivity analysis, researchers noted the optimal strategy was no follow-up.
“More literature on these key variables is needed before MRI can be considered to be beneficial in evaluation of patients with obtunded, blunt trauma,” the authors wrote. “As the Choosing Wisely Campaign is taking root among clinicians, increased awareness and discussion of the risks vs. benefits of MRI in blunt trauma will lead to a more objective evaluation of its utility.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.
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