Improving effective magnetic resonance imaging (MRI) application in soft tissue wrist injury

Abstract

Introduction: Magnetic resonance imaging (MRI) for soft-tissue wrist injury may be overprescribed, contributing to ineffective health care resource use. We aimed to discern predictive factors that may improve MRI’s application in soft-tissue wrist injury. Methods: We conducted a retrospective chart review of adults who underwent MRIs for possible soft-tissue wrist injury between June 2009 and June 2014. Clinical data and treatment recommendations before and after MRI were analyzed. If the MRI-directed treatment recommendation was different from before MRI, the MRI was noted to have influenced the patient’s treatment (Impact MRI). Results: Among 140 MRI scans, 39 (28%) impacted treatment recommendation. Twenty-six Impact MRIs were ordered by hand surgeons, whereas 13 were ordered by referring physicians (P .001). More Impact MRIs were found when an MRI was ordered for patients younger than 36 years (P .01), within 6 weeks of symptom onset (P .03), to question a specific anatomic injury (P .0001), or by a board-certified hand surgeon (P .001). Adjusting for other covariates, these 4 clinical factors were identified as independent predictive factors to Impact MRIs. Conclusions: MRIs for soft-tissue wrist injuries may more likely change management when the patient is younger, ordered within 6 weeks of symptom onset, and prescribed with a specific differential diagnosis. Referral to a hand surgeon should be considered before wrist MRI for the following patients: history of hand surgery/trauma, older than 36 years likely due to confounding chronic wrist changes, symptomatic for more than 6 weeks, and without clear differential diagnoses for the symptoms.