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Pre-MRI counseling for pediatric patients reduces need for anesthesia: study

por John W. Mitchell, Senior Correspondent | May 11, 2015
A three-year study may indicate that children who received counseling from a certified child life specialist (CCLS) were more compliant with MRI scans and, in turn, fewer cases required anesthesia. The researchers found the protocol reduced anesthesia use overall from 23 percent to 19 percent of patients, with a 10 percent drop from 45 percent to 35 percent for children aged five to ten years old.

Dr. Daniel Durand, adjunct assistant professor of radiology in the Johns Hopkins division of Pediatric Radiology, explained to DOTmed News that they (with director, Dr. Thierry Huisman and Mollie Young, CCLS) decided to conduct the study because of an observed strong correlation to anesthesia reduction when the pre-test education consultations were optional.

“For the first several years we knew we had excellent results in the subset of children with whom our CCLS were engaging,” he said. “But we wanted her to engage with more children and elective referral was not going to allow us to do that as broadly as mandatory consultation.”
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With growing evidence that doctors need to expose children to less radiation, imaging protocols increasingly favor MRI (magnets) over CT (iodizing radiation). However, because an MRI scan can take close to an hour to complete, children are challenged to lie still for that long — even with standard comfort features such as DVD players and music. Consequently, anesthesia is often used, which results in a mean increased MRI time of 1 hour and 45 minutes.

“Anesthesia will always be necessary in some cases,” Durand said. ”But the results indicate that more children can avoid the discomfort and risk of anesthesia — which may decrease stress and expense to the parent as well."

For children who don't require contrast as part of the imaging process, anesthesia can be the sole reason they need to be poked with a needle. Reducing unpleasant experiences like injections, "is what patient- and family-centered care is all about," said Durand.

No special equipment such as video goggles or other distraction devices were used in the study. Instead the CCLS provided information to the parents and children prior to the exam date. The children were educated about the test and taught coping skills (including having a parent in communication) to use if the patient felt anxious during the exam. Ultimately the CCLS decided if the child could tolerate the exam without anesthesia.

"The results were very much in keeping with what we expected,” said Durand. “We have seen referrals directly to the CCLS grow significantly over time. To me this is exciting because it means that any practice with access to CCLS staff can start up a similar program.”

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