MRI is the most cost-effective tool for assessing patients presenting with dizziness in the emergency department, according to a new analysis published Wednesday.
About 4% of U.S. ED encounters stem from this concern, with less than 5% of patients having experienced an underlying stroke. Experts have recommended specialized bedside evaluations such as HINTS to rule out the need for imaging. But implementation in acute care settings has proven difficult, experts detailed in the American Journal of Roentgenology [1].
Noncontrast head computed tomography and neck CT angiography are the most commonly used imaging exams for detecting stroke in patients dealing with dizziness. However, they are imperfect, with low sensitivity for posterior circulation stroke. Yale researchers sought to sort out the benefits of varying neuroimaging approaches, conducting a modeling study to determine dollars and quality-adjusted life years saved.
“The results suggest that choosing MRI (compared to CT or CTA) reduces stroke-related costs of care and improves outcomes by reducing the risk of recurrent stroke through improved selection and use of secondary prevention in appropriate patients,” Long H. Tu, MD, PhD, with Yale’s Department of Radiology and Biomedical Imaging, and colleagues concluded.
The team constructed a Markov decision-analytic model (a framework for forecasting a potential solution to a problem) to compare four diagnostic strategies. Those included noncontrast head CT, head and neck CTA, conventional magnetic resonance imaging, and specialized diffusion-weighted MRI. Tu and co-authors calculated cost-effectiveness in terms of life-time expenditures in 2022 U.S. dollars for each quality-adjusted life year.
Specialized MRI bested the field, resulting in the highest QALY tally and the most cost-effective strategy. Conventional MRI had the next highest health benefit, and noncontrast CT alone demonstrated the lowest utility among imaging choices.
“The findings indicate that when imaging is used to exclude stroke or to clarify a diagnosis for secondary prevention, MRI leads to better long-term outcomes and more cost-effective management,” the authors advised. “The difference in cost-effectiveness is largely driven by differences in the sensitivity of initial imaging; therefore, specialized high-sensitivity MRI protocols are preferred if feasible.”
Read more about the results, including potential study limitations, in AJR at the link below.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.