TY - JOUR T1 - Improving Effective Magnetic Resonance Imaging (MRI) Application in Soft Tissue Wrist Injury JF - The Journal of the American Board of Family Medicine JO - J Am Board Fam Med SP - 795 LP - 804 DO - 10.3122/jabfm.2018.05.170423 VL - 31 IS - 5 AU - Alfred P. Yoon AU - Alexandra L. Mathews AU - Helen E. Huetteman AU - Brett F. Michelotti AU - Kevin C. Chung Y1 - 2018/09/01 UR - http://www.jabfm.org/content/31/5/795.abstract N2 - Introduction: Magnetic resonance imaging (MRI) for soft-tissue wrist injury may be overprescribed, contributing to ineffective health care resource use. We aimed to discern predictive factors that may improve MRI's application in soft-tissue wrist injury.Methods: We conducted a retrospective chart review of adults who underwent MRIs for possible soft-tissue wrist injury between June 2009 and June 2014. Clinical data and treatment recommendations before and after MRI were analyzed. If the MRI-directed treatment recommendation was different from before MRI, the MRI was noted to have influenced the patient's treatment (Impact MRI).Results: Among 140 MRI scans, 39 (28%) impacted treatment recommendation. Twenty-six Impact MRIs were ordered by hand surgeons, whereas 13 were ordered by referring physicians (P = .001). More Impact MRIs were found when an MRI was ordered for patients younger than 36 years (P = .01), within 6 weeks of symptom onset (P = .03), to question a specific anatomic injury (P = .0001), or by a board-certified hand surgeon (P = .001). Adjusting for other covariates, these 4 clinical factors were identified as independent predictive factors to Impact MRIs.Conclusions: MRIs for soft-tissue wrist injuries may more likely change management when the patient is younger, ordered within 6 weeks of symptom onset, and prescribed with a specific differential diagnosis. Referral to a hand surgeon should be considered before wrist MRI for the following patients: history of hand surgery/trauma, older than 36 years likely due to confounding chronic wrist changes, symptomatic for more than 6 weeks, and without clear differential diagnoses for the symptoms. ER -