Purpose or Case Report: To report the success rate of non-sedate MRI studies in children 1-7 years of age and to evaluate clinical factors predictive of success.
Methods & Materials: This was a HIPAA compliant IRB approved retrospective study. We created a multidisciplinary program to decrease sedation called try-without (TWO) sedation/anesthesia. The approach includes age-appropriate ambient optimization, support from the MRI technologist, child-life (CL) specialist, and protocol optimization by radiologists. In the TWO program, children book two appointments at the time of the scheduling, a) a non-sedated MRI (usually within days of request) and b) a sedated/GA slot (usually days to weeks based on availability). If the TWO exam is successful, the subsequent sedation slot is cancelled; conversely, if the TWO is non-diagnostic, the sedation slot is maintained. Criteria for inclusion were: a) referral for TWO exam between 6/1/2018 and 5/30/2019, b) age 1-7 yrs. For study purposes, success was defined by reviewing the medical record: if the interpretation of the MRI deemed the exam satisfactory for the clinical query. For each case we recorded the age and sex of the child, type of exam (brain, spine, brain and spine, craniofacial, musculoskeletal [MSK], body [abdomen, chest]), intended duration of the protocol, and use of contrast. Descriptive statistics and means of central tendency were used to analyze demographics and clinical data. A multiple logistic regression was used to evaluate predictors of success.
Results: We analyzed data from 273 subjects (144 male,129 female) with a mean age of 4.75 years (SD 1.6). The studies were 186 (68.1%) brain, 34 (12.4%) spine, 20 (7.3%) MSK, 15 (5.4%) brain and spine, 10 craniofacial (3.6%), 6 (2.5%) body. The overall success rate was 84.6%. Success rate was 100% for MSK studies, 91% for spine, 83% for brain, 80% for craniofacial, 71% for body, and 53% for combined brain and spine. The logistic regression showed that age had a significant association with success on TWO MRI (p=0.001). Sex, duration of protocol, and use of contrast were not significant predictors of success (p>0.1). All studies performed with contrast (n=30) had successful TWO exams.
Conclusions: A multidisciplinary approach enables high success rate of non-sedated MRI in children 1-7 years of age, exceeding 80%. Success rate significantly increases with age.