Magnetic Resonance Imaging Process Variation During Musculoskeletal Infection Evaluation at 6 Pediatric Centers.

Introduction: Magnetic resonance imaging (MRI) is heavily utilized for evaluation of children suspected to have musculoskeletal infection (MSI). This allows early visualization of the anatomic and spatial extent of evolving inflammation to guide treatment decisions. Organized protocols for efficient and effective use of this diagnostic modality have been published but may not be actively followed at most pediatric centers. The purpose of this study is to comparatively evaluate MRI processes and workflows at 6 pediatric centers in the state of Texas.

Methods: Institutional Review Board approval and data use agreements were established at the centers for retrospective study of MRI practices and experience. A survey of pediatric orthopaedic surgeon principal investigators at each center assessed MRI acquisition strategies and satisfaction. Data were collected and analyzed for demographics, diagnoses, MRI indications, processes, and outcomes.

Results: Seventy children who underwent MRI evaluations over a 3-year period were included with a range of 5 to 20 children per center. Two centers had protected MRI scan time, organized MRI protocols, and facilitated immediate transfer to the operating room when surgical indications were present for sedated children. The 2 centers demonstrated significantly shorter MRIs (median 21.0 vs. 52.0 m), fewer sequences (median 3.0 vs. 7.0), less contrast use (4.0% vs. 53.3%), and a shorter delay from MRI to OR for children who underwent surgery (median 26.0 vs. 967.5 m) when compared with the remaining centers ( P <0.0001).

Conclusions: Organized MRI workflows were not followed at most centers studied. While challenging to implement and sustain, a multidisciplinary MRI protocol for MSI evaluation will make this heavily scheduled resource substantially more efficient and improve provider satisfaction.

Level of evidence: Level III-retrospective study of nonconsecutive patients.