Factors that Influence Treatment Recommendations for MRI Guided Focused Ultrasound Referrals: A Single Center Experience
Gulsah Yildiz1, David Gonzalez2, Sepehr Sani3, Neepa Patel2
1Midwestern University Arizona College of Osteopathic Medicine, 2Department of Neurological Sciences Rush University Medical Center, 3Department of Neurosurgery Rush University Medical Center
Objective:
To examine factors that influence treatment trajectories in MRI-guided Focused ultrasound (MRgFUS) thalamotomy for tremors.
Background:
After access to MRgFUS opened at our center, referrals swelled and exceeded those completing the procedure. We aim to identify factors that influence proceeding with MRgFUS such as social drivers of health (SDoH), accuracy of referral diagnosis, or adequate medication trials.
Design/Methods:
A retrospective chart review of individuals referred to our MRgFUS program between 2019-2022 was conducted. We coded patient demographics, clinical characteristics (referral diagnosis, post-workup diagnosis and treatment recommendation), decision to proceed with MRgFUS, and internal and external SDoHs (state and national Area Deprivation Index (ADIs/n), years of education, insurance status). Relationships were analyzed using chi-square and ANOVA.
Results:
We identified 280 individuals (of 297 referrals; 66.7% male, 93.9% White, Mage=71.26±9.22, Meducation=14.92±3.05. 64.6% were recommended MRgFUS (Mage=72.09), 13.2% had deep brain stimulation (DBS; Mage=68.92) and 22.1% were recommended an alternative or no procedure (Mage=65.75). The conversion rate of referrals recommended for MRgFUS/DBS to procedure was 83.9%. The average time to procedure was 11.5±17.09 weeks. Factors that influenced no procedure include: 9.64% physician recommendation of which 2% were incompatible with MRgFUS; 2.7% of patients’ diagnosis was changed and alternate treatments recommended; 24.3% patient ultimately declined procedure. Patient age (p=.004) and insurance (p=.002) had an impact on type of procedure. Other demographics, age, and ADI did not relate to recommended intervention nor time to treatment intervention.
Conclusions:
Most patients referred for MRgFUS for tremors were accurately diagnosed but often elected not to proceed with this therapy for personal reasons and/or lack of symptom severity; SDoH factors did not influence treatment, intervention.
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