Fast MRI Compared With Head CT in Evaluating Pediatric Neurologic Emergencies

BACKGROUND AND OBJECTIVES: We aimed to compare outcomes of patients who received a limited-sequence brain magnetic resonance imaging (fast MRI) with those receiving head computed tomography (CT) scans in the emergency department (ED). It was hypothesized that fast MRI would have less missed pathology while not increasing length of stay (LOS). METHODS: We conducted a planned subanalysis of a prospective cohort of children evaluated for new neurologic complaints. We compared children who underwent fast MRI at presentation (the exposure group) with 3 comparison groups of children who received a CT scan first. Participants were excluded if they had known trauma, ingestion, or metabolic disease. Two comparison participants were matched to each case and analyzed in 3 arms: random, age, and diagnosis grouping. RESULTS: Of 191 children receiving fast MRI scans, 159 were found to be eligible. These children were compared with 636 eligible children who received CT scans. Time from arrival to completed imaging was similar (fast MRI: 142 minutes vs CT: 139 minutes). Hospital LOS was also similar (fast MRI: 47 hours vs CT: 45 hours). Follow-up imaging found that fast MRI had less missed pathology than CT (MRI: 1.8% vs CT: 8.5%). Fast MRI was found to have a higher sensitivity (MRI: 95.8% vs CT: 63.0%) and a higher negative predictive value (MRI: 98.2% vs CT: 91.5%). CONCLUSIONS: This planned subanalysis found that fast brain MRI had less missed pathology, higher sensitivity, and higher negative predictive value without increasing ED or hospital LOS for patients presenting to the ED with general emergent neurologic complaints.