AJR: Subspecialty referral makes no difference for pediatric knee MRI findings
Researchers found no significant difference in the proportion of patients with abnormal findings on knee MRI based on referral by pediatricians rather than orthopedic surgeons, according to a study published in the November issue of American Journal of Roentgenology.
The results disproved the researchers’ hypothesis that patients referred by orthopedic surgeons were more likely to show abnormal findings. As pediatricians take on greater responsibility as the gatekeeper to advanced imaging or subspecialty referral, they are referring more patients directly to MRI. The impact on diagnosis, patient outcome and cost among pediatric patients is unclear.
J. Herman Kan, MD, of the department of radiology and radiological sciences at Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, Tenn., and colleagues suspected that patients referred by orthopedic surgeons might be more likely to have an abnormal result based on the preselected patient population and the specialized training of orthopedic surgeons.
To test the hypothesis, the researchers conducted a retrospective review of 501 consecutive knee MRI studies of pediatric patients referred by orthopedic surgeons and 93 consecutive knee MRI studies referred by pediatricians from January 2005 through December 2009. Patients were categorized as those with entirely normal MRI findings and those with clinically significant findings. Clinically significant findings included joint effusion, retinacular abnormality, synovitis, cartilage abnormality, ligamentous tear, meniscal tear, discoid meniscus and neoplasm.
Kan and colleagues reported entirely normal MRI findings on 24 percent of patients referred by pediatricians and 17 percent referred by orthopedic surgeons. There was no statistically significant difference in the rate of positive exams.
The researchers acknowledged that the study did not compare patients referred for MRI with those managed without advanced imaging. However, they wrote, “This study may provide information for developing clinical practice guidelines with respect to utilization of MRI in the evaluation of pediatric knee pain.” They recommended additional studies to determine potential cost-savings or differences in patient outcomes.
The results disproved the researchers’ hypothesis that patients referred by orthopedic surgeons were more likely to show abnormal findings. As pediatricians take on greater responsibility as the gatekeeper to advanced imaging or subspecialty referral, they are referring more patients directly to MRI. The impact on diagnosis, patient outcome and cost among pediatric patients is unclear.
J. Herman Kan, MD, of the department of radiology and radiological sciences at Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, Tenn., and colleagues suspected that patients referred by orthopedic surgeons might be more likely to have an abnormal result based on the preselected patient population and the specialized training of orthopedic surgeons.
To test the hypothesis, the researchers conducted a retrospective review of 501 consecutive knee MRI studies of pediatric patients referred by orthopedic surgeons and 93 consecutive knee MRI studies referred by pediatricians from January 2005 through December 2009. Patients were categorized as those with entirely normal MRI findings and those with clinically significant findings. Clinically significant findings included joint effusion, retinacular abnormality, synovitis, cartilage abnormality, ligamentous tear, meniscal tear, discoid meniscus and neoplasm.
Kan and colleagues reported entirely normal MRI findings on 24 percent of patients referred by pediatricians and 17 percent referred by orthopedic surgeons. There was no statistically significant difference in the rate of positive exams.
The researchers acknowledged that the study did not compare patients referred for MRI with those managed without advanced imaging. However, they wrote, “This study may provide information for developing clinical practice guidelines with respect to utilization of MRI in the evaluation of pediatric knee pain.” They recommended additional studies to determine potential cost-savings or differences in patient outcomes.