Pros and Cons - Ultrasound or Rapid MRI for Appy

Short Attention Span Summary

What's $5000?
Ultrasound for appendicitis is often non-diagnostic and leads to further testing or admission.  The authors hypothesized that rapid MRI would be faster and more cost-effective as initial imaging in young people with suspected appendicitis.  Such patients got ultrasound or rapid MRI based on the day of presentation, which yielded well matched cohorts and a total of 82 patients.  Those who received ultrasound first had inconclusive studies 24% of the time, leading to subsequent rapid MRI.  Those who received rapid MRI first all had conclusive findings.  However, the rapid MRI group had a 100 minute increase in ED length of stay and almost $5000 higher ED charges.  The authors concluded that MRI still took too long and cost too much and that ultrasound should be the initial imaging study of choice.  However, if like the study linked above, 74% of initial ultrasounds were non-diagnostic, the outcome may have been different.  In addition to cost and length of stay, it is also challenging to complete MRI on younger children, even with anxiolysis.

Spoon Feed
Both ultrasound and rapid MRI are viable initial imaging options in young patients with suspected appendicitis.  But in this study, MRI led to increased length of stay and significantly increased ED charges.

Source
Magnetic Resonance Imaging Versus Ultrasound as the Initial Imaging Modality for Pediatric and Young Adult Patients With Suspected Appendicitis.  Acad Emerg Med. 2017 May;24(5):569-577. doi: 10.1111/acem.13180. Epub 2017 Apr 24.

Written by Clay Smith.  Peer reviewed by Thomas Davis.