In a mathematical model, MRI after negative CT increased costs.
The NEXUS cervical spine imaging rule suggests imaging (computed tomography [CT] of the cervical spine) for neurologically intact patients with midline tenderness. However, many providers follow a negative CT scan with magnetic resonance imaging (MRI). Is this approach good for patients? In the absence of clinical trial data, investigators addressed this question with a cost-effectiveness analysis.
The model assumed that a 40-year-old patient was neurologically intact but had midline cervical spine tenderness, and, based on prior literature, that MRI has a false-positive rate of 25% to 40%. The analysis compared a strategy of CT only and a strategy of MRI follow-up if the CT result was negative. The CT-only strategy was superior, with lower …
Reviewing Author
DisclosuresConsultant/Advisory BoardPortola Pharmaceuticals, Inc.
Speaker’s BureauPeerView Institute for Medical Education
Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals
DisclosuresConsultant/Advisory BoardPortola Pharmaceuticals, Inc.
Speaker’s BureauPeerView Institute for Medical Education
Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals