Barriers to timely MRI in acute spinal cord injury: a retrospective review

Background: Magnetic Resonance Imaging (MRI) is frequently used to determine if surgical treatment is warranted in the setting of acute Spinal Cord Injury (SCI). Imaging delays may delay surgery and affect outcomes. This retrospective review aims to identify factors associated with delays in MRI in patients presenting with acute SCI. Methods: Patients >18 years old presenting to one Level 1 Trauma Center and receiving spinal MRI for acute SCI between January 2021-February 2023 were included. Two-step clustering was used to identify three distinct groups to compare variables predictive of time to MRI. Results: 436 patients are included in the analyses. Median time to MRI was 487.5 (interquartile range [IQR] 309.5, 1204.25) minutes. The data contained three unique clusters: Early (median time 387 min, n = 324), Delayed (median 1819 min, n = 86), and Very Delayed (median 4552 min, n = 26). Several differences were observed between groups in mean arterial pressure, Injury Severity Score, Glasgow Coma Scale, and activation of priority codes at initial presentation. Conclusions: Patient medical instability may deprioritize completion of advanced imaging. Time to initial managing consult also plays a role in MRI timing; however, patients who are assessed between 24 and 48 h since initial presentation are potentially poised to benefit most from a standardized MRI protocol, as our data did not show a difference in demographic or clinical variables when comparing them to those assessed early.