Improving Effective Magnetic Resonance Imaging (MRI) Application in Soft Tissue Wrist Injury.

Abstract

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. 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). 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 (<i>P</i> = .001). More Impact MRIs were found when an MRI was ordered for patients younger than 36 years (<i>P</i> = .01), within 6 weeks of symptom onset (<i>P</i> = .03), to question a specific anatomic injury (<i>P</i> = .0001), or by a board-certified hand surgeon (<i>P</i> = .001). Adjusting for other covariates, these 4 clinical factors were identified as independent predictive factors to Impact MRIs. 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.