Success of Nonsedated Neuroradiologic MRI in Children 1-7 Years Old.

Abstract

<b>BACKGROUND.</b> MRI use and the need for monitored anesthesia care (MAC) in children have increased. However, MAC is associated with examination delays, increased cost, and safety concerns. <b>OBJECTIVE.</b> The purpose of this study was to evaluate the success rate of nonsedated neuroradiologic MRI studies in children 1-7 years old and to investigate factors associated with success. <b>METHODS.</b> We retrospectively reviewed data from our institutional nonsedated MRI program. Inclusion criteria were outpatient nonsedated MRI referral, age 1-7 years old, and neuroradiologic indication. Exclusion criteria were MRI examinations for ventricular checks and contrast material use. Success was determined by reviewing the clinical MRI report. We recorded patient age and sex, type of MRI examination (brain, spine, craniospinal, head and neck, and brain with MRA), protocol length, presence of child life specialist, video goggle use, and MRI appointment time (routine daytime appointment or evening appointment). We used descriptive statistics to summarize patient demographics and clinical data and logistic regression models to evaluate predictors of success in the entire sample. Subset analyses were performed for children from 1 to < 3 years old and 3 to 7 years old. <b>RESULTS.</b> We analyzed 217 patients who underwent nonsedated MRI examinations (median age, 5.1 years). Overall success rate was 82.0% (<i>n</i> = 178). The success rates were 81.4% (<i>n</i> = 127) for brain, 90.3% (<i>n</i> = 28) for spine, 71.4% (<i>n</i> = 10) for craniospinal, 66.7% (<i>n</i> = 6) for head and neck, and 100% (<i>n</i> = 7) for brain with MRA. Age was significantly associated with success (odds ratio [OR], 1.33; <i>p</i> = .009). In children 1 to < 3 years old, none of the factors analyzed were significant predictors of success (all, <i>p</i> > .48). In children 3-7 years old, protocol duration (OR, 0.96; 95% CI, 0.93-0.99; <i>p</i> = .02) and video goggle use (OR, 6.38; 95% CI, 2.16-18.84; <i>p</i> = .001) were significantly associated with success. <b>CONCLUSION.</b> A multidisciplinary approach with age-appropriate resources enables a high success rate for nonsedated neuroradiologic MRI in children 1-7 years old. <b>CLINICAL IMPACT.</b> Using age as the primary criterion to determine the need for MAC may lead to overuse of these services. Dissemination of information regarding nonsedated MRI practice could reduce the rate of sedated MRI in young children.