MAGNETIC-RESONANCE-IMAGING - UTILIZATION IN THE MANAGEMENT OF CENTRAL-NERVOUS-SYSTEM TRAUMA

Objective: To determine the availability, use, and perceived value of magnetic resonance imaging (MR) in the management of acute central ner vous system (CNS) trauma in United States Level I(or equivalent) traum a centers (TCs), Design, Materials, and Methods: One hundred sixty-nin e American College of Surgeons, state or locally designated Level I(or equivalent) TCs were identified using compiled lists and telephone co ntacts, Surveys about MR use in CNS trauma were mailed to each institu tion, Follow-up telephone calls were made to nonresponding institution s, Data were analyzed using frequency distribution, Measurements: Usin g returned questionnaires from trauma directors and follow-up telephon e contacts, data on the physical location, technologist availability, and patient monitoring capabilities were accrued, The questionnaire ad dressed the perceived value and cost-effectiveness of MR for acute CNS trauma in general, distinguishing between spinal cord and traumatic b rain injury, using a Likert-type rating scale, Main Results: One hundr ed nine (65%) of identified TCs responded by mail. Sixty (33%) require d contact by telephone, One hundred fifty-two (93%) reported MR scanne rs ''on site.'' Five of seven TCs without on-site MR had facilities wi thin 5 miles, No TC reported the inability to obtain MR scans, Seventy -four percent of TCs reported MR angiography capabilities, Ninety-seve n percent of MR facilities were staffed 24 hours per day, 83% by on-ca ll, out of-hospital technologists at night and on weekends, TCs report ed patient monitoring capabilities including cardiac monitoring (83%) and pulse oximetry (91%), Seventy-one percent reported the ability to scan intubated patients, Forty-five percent of TCs ''rarely'' use MR, 51% report ''occasional'' use, and 4% ''frequently'' use MR for acute trauma, Ninety-four percent of trauma directors agreed or strongly agr eed that MR directed management and was cost-effective for spinal cord trauma, Fifty-four percent agreed or strongly agreed that MR directed management and was cost-effective for traumatic brain injury, No corr elation existed between perceptions of MR applicability in CNS trauma and the number of trauma admissions or on-site availability, Conclusio ns: Most trauma directors consider MR important in the acute evaluatio n of spinal trauma and, to a lesser extent, for traumatic brain injury , Despite these opinions, the vast majority of these centers reported only ''rare'' to ''occasional'' use of MR in the setting of acute CNS trauma, Our results show that most TCs have on-site and continuously a vailable MR facilities capable of cardiac and pulmonary monitoring, Ot her factors such as the higher relative cost of MR may be responsible for the discrepancy between the perceived value and the actual utiliza tion of MR imaging in the setting of CNS trauma.