Title : After-hours urgent spine MRI for spinal cord compression - does it change the patient's after-hours management?
Spinal cord compression (SCC) is an neurological and neurosurgical emergency which occurs either when tumour, abscess or haematoma spreads into the spinal canal or from fracture of vertebra causing spinal cord compression. There is potentially devastating and irreversible damage occurring within hours to days and therefore rapid diagnosis is critical. Most hospitals in Australia do not operate an out-of-hours MRI service and therefore patients need to be transferred to the local tertiary centre where radiographers and radiologists are called back to perform and report the imaging.
This study was aimed at determining the extent to which after-hours diagnostic magnetic resonance imaging (MRI) of the spine for spinal cord compression was appropriate within the case hospital and whether or not it changed management after-hours.
We reviewed radiology results in all patients undergoing emergency after-hours MRI within our local health district for suspected spinal cord compression or cauda equina syndrome over a 2-year period and reviewed their medical record. Outcome measures: percentage of positive MRI studies for metastatic spinal cord compression, percentage of those patients who subsequently had emergency treatment.
A total of 269 after-hours emergency MRI studies were performed to evaluate for spinal cord compression with 73 studies positive for spinal cord compression (27.4%) and subsequently 15 patients (20.6% of the positive studies) who had emergency treatment that same night. 79.4% of patients with spinal cord compression found on emergency after- hours MRI did not receive emergency treatment that same night. Many factors contributed to delaying treatment including lack of acute neurological signs and symptoms, recent radiotherapy or surgery, new lesion awaiting biopsy, conflicts in scheduling for emergency theatre with other urgent cases and patient declining to proceed with surgery.
This study adds to the existing data regarding the utility of after-hours MRI service in the evaluation of spinal cord compression. There are potentially devastating consequences with high morbidity if the diagnosis of spinal cord compression is missed. However, it may be appropriate to advise that some patients can be imaged in-hours early the next day if the patient is not a candidate for treatment that same night.