Selective Use of Magnetic Resonance Imaging for Facial Palsy in the Pediatric Emergency Department

Objectives: This retrospective observational study evaluated the diagnostic efficiency of routine magnetic resonance imaging (MRI) in pediatric patients with facial palsy (FP) in the emergency department (ED). Methods: Pediatric patients under 18 years of age who presented with FP at the ED of a single tertiary referral hospital between January 2010 and December 2022 were included. Clinical features were assessed and used for risk stratification, which informed the diagnostic utility of the MRI. Results: A total of 134 pediatric patients were included [mean age, 99 mo; 53.7% male (n = 72)]. Seventeen patients (12.7%) were diagnosed with central FP (CFP). Among the clinical features, additional neurological examination abnormalities emerged as the most significant risk factor for CFP (odds ratio, 86.3; P < 0.001). Risk stratification based on neurological abnormalities, underlying conditions, and associated symptoms revealed that the diagnostic utility of MRI was significantly higher in the risk group than in the no-risk group ( P < 0.001; sensitivity, 100%; specificity, 84.6%). In contrast, patients in the no-risk group who underwent MRI experienced a mean increase of 294 minutes in the ED length of stay compared with those who did not undergo imaging. Conclusions: Routine MRI is valuable for detecting CFP in pediatric patients with neurological signs. However, its use in low-risk cases may provide limited clinical benefit, prolonging ED stay and increasing unnecessary use of medical resources. Therefore, selective imaging based on clinical indicators is recommended.