Should primary care physicians order MRIs for adult patients with knee pain?
When primary care physicians refer adult patients for MR imaging for traumatic knee symptoms, it provides no additional value and leads to higher healthcare costs, according to a new study by Dutch researchers published in Radiology.
“Although the majority of knee MR examinations are still requested by orthopedic surgeons (with well-established added value), in the past decade, a shift toward earlier MR imaging in primary care has been seen,” wrote lead author Kim van Oudenaarde, MD, MSc, department of radiology at Leiden University Medical Center in Leiden, the Netherlands, and colleagues. “The suggested potential beneficial effects of MR imaging in primary care are as follows: In case of negative findings, patients can be reassured and might be able to avoid unnecessary referrals to secondary care. In case of positive findings, an earlier diagnosis can be made, potentially resulting in earlier recovery. However, due to the lack of evidence regarding the added value of MR imaging in primary care, the Dutch College of General Practitioners guidelines recommend not to request MR imaging in these patients.”
The authors studied more than 350 patients with traumatic knee symptoms treated between November 2012 to December 2015. The patients’ mean age was 33 years old. Patients were randomly assigned to either MR imaging within two weeks of injury or “usual care,” which consisted of being referred to an orthopedic surgeon “when conservative treatment was unsatisfactory.”
Overall, the mean quality-adjusted life years (QALYs) was 0.899 for patients in the usual care group and 0.888 for patients in the MRI group. Also, healthcare costs were higher for patients in the MR group.
“MR imaging led to more healthcare costs, without improving health outcomes,” the authors wrote. “Although our exploratory analyses indicated that a subgroup of patients might exist in whom MR imaging could be cost-effective, the characteristics of this subgroup need to be evaluated in a future study. For the moment, usual care as described in the Dutch general practice guidelines without referral for MR imaging and with referral to an orthopedic surgeon in patients with persistent knee symptoms should be the guideline of choice.”
The authors added that their results can also be applied to other health systems where providers other than orthopedic surgeons are involved in treating patients with traumatic knee injuries.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.