P42. When does MRI change management of pediatric back pain? A predictive scoring system

BACKGROUND CONTEXT The prevalence of back pain in the pediatric population is increasing and represents a global burden. Workup and management of back pain in this population presents a clinical challenge. Although many cases are self-limited, failure to diagnose a pathology that requires clinical intervention can carry severe repercussions. Oftentimes the challenge facing spine specialists with this population is determining when to order advanced imaging, such as magnetic resonance imaging (MRI). MRI carries a high cost to the patient and health care system, and may even require procedural sedation in the pediatric population. Understanding when an MRI will help guide clinical management may help improve the quality and timeliness of care, while also reducing costs. PURPOSE The aim of this study was to develop a predictive scoring system based on pediatric patient factors to help determine when an MRI will change clinical management. STUDY DESIGN/SETTING This study is a retrospective cohort analysis from a single orthopedic surgery practice, composed of orthopedic spine surgeons and pediatric orthopedic surgeons. PATIENT SAMPLE Consecutive pediatric patients (less than 21 years old) who presented to clinic with a chief complaint of back pain between 2010 and 2018. OUTCOME MEASURES The primary outcome measured was whether or not an MRI directly contributed to a change in clinical management of the patient. Examples of a change in management include changing the duration or type of conservative care, indicating a patient for surgery, contraindicating a patient for surgery, or reveal findings that require additional advanced imaging. METHODS Demographic factors analyzed included age, sex, body mass index (BMI), and comorbid conditions. Presentation variables analyzed included the duration of symptoms, primary location of pain (cervical, thoracic, or lumbar), the presence of arm or leg pain, nocturnal symptoms, weight loss, fevers or chills, history of trauma, sudden onset of pain, and whether or not the injury was sports related. If a patient had advanced imaging, such as MRI, a physician reviewer determined whether or not the imaging resulted in a change of management based on comprehensive chart review. A predictive model of factors that influence whether MRI results in a change in imaging was then generated using cross-validation LASSO logistic regression analysis. RESULTS A total of 729 patients were included, with a mean age of 15.1 years (range: 3 to 20 years). Of these, 344 (47.2%) had an MRI. On bivariate analysis, the presence of leg pain (p CONCLUSIONS A predictive model was generated to help determine when ordering an MRI may result in a change in clinical management for workup of back pain in the pediatric population. The main factors included a neuro deficit, nocturnal symptoms, sudden onset, leg pain, lumbar pain, and age. Spine specialists can use these findings to better determine if and when an MRI might be appropriate. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.