Acute peripheral joint injury: cost and effectiveness of low-field-strength MR imaging--results of randomized controlled trial.
Acute peripheral joint injury: cost and effectiveness of low-field-strength MR imaging--results of randomized controlled trial.
复制标题
急性周围关节损伤：低场强磁共振成像的成本和有效性——随机对照试验的结果。
作者：
J. J. Nikken;E. Oei;A. Ginai;G. Krestin;J. Verhaar;A. V. van Vugt;M. G. M. Hunink
目的
前瞻性评估在近期腕关节、膝关节或踝关节急性创伤性损伤患者中，与当前的诊断性成像策略（单独使用放射学检查）相比，在放射学检查的基础上使用低场强专用磁共振（MR）成像进行的简短成像检查是否有效且节约成本。
材料和方法
获得机构审查委员会批准和知情同意。近期腕关节、膝关节或踝关节创伤的患者被随机分为两组：单纯X线摄影（参考组）或X线摄影后进行简短的MR成像检查（干预组）。有效性指标包括额外诊断程序的数量、至最后一次诊断程序的时间和缺勤天数。使用精确Wilcoxon-Mann-Whitney检验分析有效性指标。采用t检验分析康复时间和生活质量。从社会角度进行成本分析，并采用t检验进行分析。
结果
500例腕关节、膝关节或踝关节急性损伤患者（207例女性，293例男性;平均年龄34.8岁）被随机分组。在干预组中，膝关节损伤患者的生活质量在前6周内显著更高，完成诊断检查的时间显著更短（干预组平均为3.5天，参考组为17.3天）。对于膝关节损伤患者，干预组的额外诊断程序数量显著低于参考组（分别为9 vs 35）。膝关节损伤患者的成本差异最大（干预组，1820 [1966美元];参考组，2231 [2409美元]），这是由于生产力损失减少。手腕受伤的患者的费用更高，脚踝受伤的患者的费用几乎相等。然而，所有成本差异都不显著。
结论
与X线摄影相比，急性腕关节或踝关节损伤患者的MR成像既不节省成本，也不能有效加快诊断工作或改善生活质量。在膝关节损伤患者中，简短的MR成像检查缩短了完成诊断检查的时间，减少了额外诊断程序的数量，提高了前6周的生活质量，并可能降低与生产力损失相关的成本。
PURPOSE
To assess prospectively if a short imaging examination performed with low-field-strength dedicated magnetic resonance (MR) imaging in addition to radiography is effective and cost saving compared with the current diagnostic imaging strategy (radiography alone) in patients with recent acute traumatic injury of the wrist, knee, or ankle.
MATERIALS AND METHODS
Institutional review board approval and informed consent were obtained. Patients with recent trauma of the wrist, knee, or ankle were randomized across two diagnostic strategies: radiography alone (reference group) or radiography followed by a short MR imaging examination (intervention group). Measures of effectiveness included the number of additional diagnostic procedures, time to last diagnostic procedure, and number of days absent from work. Measures of effectiveness were analyzed by using an exact Wilcoxon-Mann-Whitney test. Time to convalescence and quality of life were analyzed by using a t test. Cost analysis was performed from a societal perspective and analyzed by using a t test.
RESULTS
Five hundred patients (207 women, 293 men; mean age, 34.8 years) with acute injury of the wrist, knee, or ankle were randomized. In the intervention group, quality of life for patients with knee injuries was significantly higher during the first 6 weeks, and time to completion of diagnostic work-up was significantly shorter (mean, 3.5 days for intervention group vs 17.3 days for reference group). The number of additional diagnostic procedures was significantly lower in the intervention group versus the reference group (nine vs 35, respectively) for patients with knee injuries. Patients with knee injuries showed the largest difference in costs (intervention group, 1820 [$1966]; reference group, 2231 [$2409]) owing to a reduction in productivity loss. Costs were higher in patients with wrist injuries and almost equal in patients with ankle injuries. All cost differences, however, were not significant.
CONCLUSION
Compared with radiography, MR imaging in patients with acute wrist or ankle injuries is neither cost saving nor effective in expediting diagnostic work-up or improving quality of life. In patients with knee injuries, a short MR imaging examination shortens the time to completion of diagnostic work-up, reduces the number of additional diagnostic procedures, improves quality of life in the first 6 weeks, and may reduce costs associated with lost productivity.