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Study Finds Redundant Imaging In Stroke Tests

March 8, 2012
Written by: , Filed in: Diagnostic Imaging, Emergency Radiology, Neuroradiology
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Perhaps it’s the equivalent of wearing both suspenders and a belt, just to be sure. A multistate study found that MRI use is increasing as a test for stroke, but it’s not replacing CT. Instead, it’s supplementing CT.

The duplication, the study suggests, wastes money.

Lead author James F. Burke, MD, summed up the findings this way:

Compared to CT, MRI is a more accurate test for stroke. But our results showed that MRI is not replacing CT as the primary stroke neuroimaging study. Instead, patients are getting both. Minimizing the use of multiple studies could be a viable strategy to reduce costs.

Dr. Burke is a clinical lecturer in neurology at the University of Michigan Medical School. He was quoted in a University of Michigan Health System news release.

The study, published in the February issue of Annals of Neurology, looked at changes in MRI use from 1999 to 2008. Examining databases from emergency departments in 11 states, the researchers found that MRI tests were used in 28 percent of stroke cases in 1999. That usage increased to 66 percent of cases in 2008.

CT use, meanwhile, also increased, albeit slightly, from 92 percent in 1999 to 95 percent in 2008. The costs of inpatient stroke care also increased during that period, by 42 percent, or $3,800 per case. Neuroimaging made up the largest component of that cost increase.

The study describes MRI as more accurate than CT in the diagnosis of stroke, but more costly and time-consuming. Dr. Burke noted, “There currently are not evidence-based guidelines that preferentially recommend either MRIs or CT.”

There aren’t any guidelines that recommend both, either. Said Dr. Burke:

This represents an area where we have an opportunity to substantially reduce the cost of care without adversely affecting the quality of care.

An accompanying Annals of Neurology editor’s message by S. Claiborne Johnston, MD, PhD, and Stephen L. Hauser, MD, says, “The issue of duplicative imaging in stroke is just one example of wasteful care. Quite simply, it is very easy to order more tests and to treat with more expensive therapies.”

The message said physicians needed to take responsibility for decreasing wasteful spending. “The failure to find a political solution to rising healthcare costs only increases our responsibility to become leaders and not victims,” the message said.

Related seminar: Neuro & Musculoskeletal Imaging

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