Success of Nonsedated Neuroradiologic MRI in Children 1–7 Years Old

Background: MRI utilization and need for monitored anesthesia care (MAC) in children have increased. However, MAC is associated with exam delays, increased cost, and safety concerns. Objective: To evaluate the success rate of non-sedated neuroradiological MRI studies in children 1-7 years old and to investigate factors associated with success. Material and Methods: We retrospectively reviewed data from our institutional non-sedated MRI program. Criteria for inclusion were: a) outpatient non-sedated MRI referral b) ages of 1-7 years and c) neuroradiology indication. Criteria for exclusion were: a) ventricular check MRI exams and b) exams with contrast material. Success was determined by reviewing the clinical MRI report. We recorded the age, sex, type of exam (brain, spine, craniospinal, head and neck, and brain with MRA), protocol length, presence of child life specialist, use of video goggles, and time of the MRI appointment (routine daytime slot, evening slot). Descriptive statistics were used to summarize patient demographics and clinical data. Logistic regression models were used to evaluate predictors of success in the entire sample. Subset analyses were performed for children between 1-3 years and 3-7 years. Results: We analyzed 217 non-sedated MRI exams (median age: 5.1 years). Overall success rate was 82.0% (n=178). The success rate was 81.4% (n=127) for brain, 90.3% (n=28) for spine, 71.3% (n=10) for craniospinal, 66.7% (n=6) for head and neck, and 100.0% (n=7) for brain with MRA. Age was significantly associated with success (OR 1.33, P=0.009). In children with age range 1-3 years, none of the factors analyzed were significant predictors of success (all, P > 0.484). In children between 3-7 years, protocol duration (OR 0.96, 95%CI 0.93 - 0.99, P = 0.016) and use of video goggles (OR 6.38, 95%CI 2.16 - 18.84, P = 0.001) were significantly associated with success. Conclusion: A multidisciplinary approach with age-appropriate resources enables high-success rate for non-sedated neuroradiological MRI in children 1-7 years old. Clinical Impact: Using age as the primary criterion to determine the need for MAC may lead to overutilization of these services. Dissemination of non-sedated MRI practice could reduce the rate of sedated MRI in young children.