Purpose: Although proven unnecessary, MRIs continue to be used by primary care physicians (PCPs) for routine diagnostic purposes in symptomatic knee pain in the elderly with clear radiographic evidence of osteoarthritis. This study aims to show the financial burden these MRIs pose on the healthcare system.
Methods: A retrospective analysis of medical records and plain radiographs was performed on elderly patients (age ≥ 60 years) who were referred by their PCPs to our practice, with a chief complaint of knee pain. Demographic and clinical variables were gathered to elucidate any factors that might correlate with receiving MRIs. Radiographs were evaluated using the Kellgren- Lawrence (K-L) score. Calculated costs were based on low-end and high-end estimates of MRI cost for 2014.
Results: Overall, 767 patients who presented to our clinic met the inclusion criteria and were evaluated for this study. Two hundred twenty-five (29.3%) of the patients received plain radiographs from their PCPs without additional imaging. Seventy-seven (10%) of patients received MRIs for diagnostic purposes by their PCP. Demographic variables did not correlate with a patient receiving MRI (p>0.05). Patients who presented with unilateral knee pain were more likely to receive an MRI (p=0.008).
Conclusion: PCPs continue to underutilize plain radiographs and over utilize MRIs for diagnostic purposes in patients with clear evidence of osteoarthritis. If the rate of 19.25 unnecessary MRIs per orthopedic surgeon is projected to a national scale, the projected wasted finances are estimated to be between $349.2 million and $922.9 million.
Seungwhan Roh, Carolyn M Battaglia, Samuel P Robinson
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