Emergency Medicine Physicians’ and Pediatricians’ Use of Computed Tomography in the Evaluation of Pediatric Patients With Abdominal Pain Without Trauma in a Community Hospital

Grim, P.

doi:10.1177/0009922813517170

Cited by 6 publications

(10 citation statements)

References 16 publications

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“…Stanley et al 52 Physician training type was associated with variability in CT use, with the greatest overall rate of CT use in physicians with emergency medicine training alone, and the lowest overall rate of CT use in paediatric residents.…”

Section: Physician Training Typementioning

confidence: 99%

“…A higher CT scan rate of 2-2.4 fold was shown in general hospital EDs. 39,50 Stanley et al 52 demonstrated a substantial variation in the use of head CT in children presenting to the ED with minor TBI, across 25 general EDs in the USA. This variation was not explained by the rate of positive CT scans, or by the severity clinical findings, implying overuse of CT. Children with low to middle risk received head CT scans at higher rates in suburban hospitals and non-children hospitals.…”

Section: Head Ctmentioning

confidence: 99%

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Overuse of CT and MRI in paediatric emergency departments

Ohana

Soffer

Zimlichman

et al. 2018

The British Journal of Radiology

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The aim of this review is to survey CT and MRI overuse in the paediatric emergency department (ED) population. CT is one of the most important modalities employed in the ED. Not surprisingly, its high accuracy, rapid acquisition and availability have resulted in overuse. An obvious limitation of CT is ionizing radiation; in addition there are economic implications to overuse. Studies from the last two decades have shown increase in paediatric ED CT utilization in the first decade, reaching a plateau forming around 2008, followed by a decrease in the last decade. This decrease occurred in conjunction with campaigns raising awareness to the risks of radiation exposure. Although a trend of decrease in overuse have been observed, great variability has been shown across different facilities, as well as among physicians, with more pronounced overuse in non-teaching and non-children dedicated EDs. The leading types of paediatric ED CTs are head and abdominal scans. Decision rules, such as PECARN for head injury and the Alvarado score for abdominal pain, as well as using alternative imaging modalities, have been shown to reduce CT overuse in these two categories. MRI has the obvious benefit of avoiding radiation exposure, but the disadvantages of higher costs, less availability and less tolerability in younger children. Although anecdotally paediatric ED MRI usage has increased in recent years, only scarce reports have been published. In our opinion, there is need to conduct up-to-date studies covering paediatric CT and MRI overuse trends, usage variability and adherence to clinical protocols.

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Section: Physician Training Typementioning

confidence: 99%

Section: Head Ctmentioning

confidence: 99%

Overuse of CT and MRI in paediatric emergency departments

Ohana

Soffer

Zimlichman

et al. 2018

The British Journal of Radiology

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“…Third, because there was no detailed hospital information in the database, our study was unable to evaluate the factors used in previous studies, such as children's hospitals, teaching hospitals, and emergency hospitals. 32,33,[41][42][43][44] Finally, we did not consider the history of CT use, which might affect the choice of CT use. Because of cumulative radiation exposure, physicians may hesitate to perform repeated CT.…”

Section: Discussionmentioning

confidence: 99%

Recent Trend of Using Computed Tomography to Diagnose Pediatric Appendicitis at the First Hospital Visit

Yoneyama

Sato²,

Nakashima

et al. 2023

Pediatr Emer Care

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ObjectiveWe recognize that computed tomography (CT) should not be used to diagnosis pediatric appendicitis due to radiation exposure. However, few studies have recently shown a trend in its use. This study aimed to investigate the annual use of CT for the diagnosis of pediatric appendicitis at the first hospital visit.MethodsThis was a descriptive study using nationwide claims data. We extracted the data of children younger than 15 years who underwent imaging tests to diagnose acute and suspected appendicitis at the first visit between January 2008 and September 2018. We summarized the patient characteristics and the percentage of CT, ultrasonography (US), or CT/US utilization by year, age, and department.ResultsWe identified 6658 children who underwent CT (2349 [35.8%]), US (53,57 [54.5%]), and CT/US (634 [9.7%]). The annual CT use dropped from 43.1% in 2012 to 29.4% in 2018. According to age group, the highest percentage of CT use in 2018 was 84.6% in preschool children, followed by adolescents (40.3%), upper-grade (26.0%), and lower-grade (15.0%) children. Data of annual CT use by department revealed that CT usage was much higher in internal and emergency medicine than in pediatrics. Furthermore, adolescents accounted for approximately 50% of CT use in internal medicine.ConclusionsThe percentage of CT use for pediatric appendicitis at the first visit declined annually. However, CT use still tended to be higher in preschool- and adolescent-aged children, or in departments other than pediatrics. Further studies are required to clarify the clinical benefits of CT use to diagnose pediatric appendicitis.

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“…Of those unlikely, 9.1% [4] were abnormal and 11.4% [5] were equivocal. Of those equivocal, 8.9% [4] were abnormal and 15.6% [7] were equivocal.…”

Section: Likelihood Of Positive Findings On Axrmentioning

confidence: 96%

“…However, AXR remains the initial modality used in many occasions [5]. Studies have shown variability in the ordering rates of imaging studies among different groups of providers but no outcome differences have been demonstrated [6,7].…”

Section: Introductionmentioning

confidence: 99%