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E1200. Association Between Brain MRI Utilization and Inpatient Clinical Outcomes in Traumatic Brain Injury Patients
Authors
  1. Hwan Lee; Department of Radiology, University of Pennsylvania Perelman School of Medicine
  2. Yifeng Yang; Department of Internal Medicine, University of Iowa Hospitals & Clinics
  3. Jiehui Xu; Division of Biostatistics, New York University Grossman School of Medicine
  4. Jeffrey Ware; Department of Radiology, University of Pennsylvania Perelman School of Medicine
  5. Baogiong Liu; Department of Internal Medicine, University of Iowa Hospitals & Clinics
Objective:
While computed tomography is the primary imaging modality for evaluation of patients with acute traumatic brain injury (TBI), magnetic resonance imaging (MRI) has higher sensitivity for certain types of injuries such as contusions, small hemorrhages, and axonal injury (1,2). Whether increased detection of intracranial injuries in acute TBI patients with MRI may lead to improved clinical outcomes, however, remains an important unanswered question given the cost and practical difficulties associated with performing MRI in hospitalized TBI patients. In this study, we leverage a large national patient database to examine associations between brain MRI utilization in hospitalized TBI patients and inpatient clinical outcomes.

Materials and Methods:
The National Inpatient Sample database was queried to find a sample of patients who were hospitalized for TBI between 2012 and 2014 in the United States. TBI patients who underwent brain MRI during their hospitalization (n=3,075) were compared to TBI patients who did not receive MRI (n=340,090) with regard to demographic and clinical characteristics including gender, age, ethnicity, income, insurance type, hospital type, and comorbidities. Multivariate regression analysis was performed to independently evaluate the association between brain MRI utilization and inpatient mortality rate, complications, as well as the length and cost of hospital stay.

Results:
The MRI group had a lower unadjusted mortality rate of 0.75% compared to 2.54% in the non-MRI group. On multivariate regression analysis, inpatient brain MRI was independently associated with lower mortality (adjusted OR 0.32, 95% CI 0.12-0.86, P=0.024), as well as higher rates of intracranial hemorrhage (adjusted OR 2.20, 95% CI 1.27-3.81, P=0.005) and non-home discharge (adjusted OR 1.33, 95% CI 1.07-1.67, P=0.012). No significant difference in the incidence of gastrostomy (P=0.093) or tracheostomy (P=0.806) was observed between the two groups. Unadjusted average length of stay was longer in the MRI group at 5.9 days compared to 3.9 days in the control group. The average total cost of hospitalization was also higher at $15,559 in the MRI group compared to $10,633 in the non-MRI group. On multivariate regression analysis, brain MRI was independently associated with 51% (95% CI 31-73%, P<0.001) and 52% (95% CI 34-72%, P<0.001) increase in the total length and cost of hospital stay, respectively.

Conclusion:
Inpatient brain MRI utilization in TBI patients is associated with lower inpatient mortality, but with increased hospital resource utilization and likelihood of non-home discharge. Further research is needed to clarify the nature of these associations and understand how MRI may be used to improve clinical outcomes in TBI patients.