A new study published online March 14 in JAMA Surgery suggest that magnetic resonance imaging (MRI) follow-up appears not to be beneficial after normal cervical computed tomography (CT) findings in patients with blunt trauma of the cervical spine.

Xiao Wu, from the Yale School of Medicine in New Haven, Conn., And colleagues conducted a cost-effectiveness analysis to assess an average patient (aged 40 years) with blunt trauma. The utility and cost-effectiveness of MRI versus no follow-up after normal cervical CT findings were assessed.

The analysis used a Markov decision model from a societal perspective with variables from systematic reviews and meta-analyzes and reimbursement rates from the Centers for Medicare & Medicaid Services, National Spinal Cord Injury Database, and other large published studies.

The researchers found that the cost of MRI follow-up was $ 14,185 with a health benefit of 24.02 quality-adjusted-life-years (QALYs) in the base case of a 40-year-old patient; the cost of no follow-up was $ 1,059 with a health benefit of 24.11 QALYs. No follow-up was shown to be the best strategy in all 10,000 iterations in probabilistic sensitivity analysis.

When the negative predictive value of the initial CT was relatively high (> 98%), or the risk of an injury treated with a cervical collar turning into a permanent neurologic deficit was higher than 25%, or when the risk of a missed injury turning into a neurologic deficit was less than 58%, no follow-up was the better strategy.

"Magnetic resonance imaging had a lower benefit and a higher cost compared with no follow-up after a normal CT finding in patients with blunt trauma to the cervical spine, a finding that does not support the use of MRI in this group of patients," the authors noted.

The conclusion is robust in sensitivity analyzes varying key variables in the model. More literature on these key variables is needed before MRI can be considered to be beneficial in the evaluation of obtunded blunt trauma.