Nationwide Emergency Department Imaging Practices for Pediatric Urolithiasis: Room for Improvement

Abstract

Purpose Children are particularly vulnerable to the harmful effects of medical radiation, and children with urolithiasis are one group who may receive repeated radiation-intensive imaging tests. Our study aimed to characterize imaging practices for children presenting to the emergency department (ED) with suspected urolithiasis (SU) and determine factors associated with the choice of imaging study. Methods Using the 2006-10 Nationwide Emergency Department Sample (NEDS), we conducted a retrospective cohort study of patients <18 years old presenting with SU. We determined imaging practices for visits in EDs where billing codes for computed tomography (CT) and ultrasound were reliably reported. Logistic regression was used to delineate patient- and hospital-level factors associated with the use of CT vs. ultrasound. Results There were 18096 pediatric SU visits in the 1191 NEDS EDs with reliable imaging codes. Of the 11215 patients receiving a CT alone, an ultrasound alone, or both, 9773 (87%) were imaged with CT alone. CT use peaked in 2007, and declined thereafter. On multivariate analysis, the following factors were associated with the use of CT alone: lower proportion of pediatric patients treated in the ED, older age, location in the Midwest or South, evaluation at a non-teaching hospital, and visit on a weekend. Conclusions CT use is highly prevalent for children presenting with SU. The lowest CT use is in EDs that care for more children. Ultrasound is used very infrequently regardless of site. Awareness regarding risks of CT and consideration of alternatives including ultrasound are warranted in caring for these patients.

Ureteroscopy for Paediatric Renal Tract Stones - Outcomes from a Tertiary European Centre

“…A more recent paper has shown that up to 87% of paediatric emergency admissions with suspected urolithiasis were imaged with CT [12]. Yet the same authors recommend an increased use of ultrasound to avoid the radiation exposure and potential cancer risk encountered as a result of CT scanning [12]. In our patient group only 18% of patients were subjected to a CT scan with the majority of these being performed initially in other units prior to referral to our tertiary centre.…”

“…However, despite this recommendation a recent US paper has shown an increase in the use of CT scanning from 26% in 1999 to 45% in 2008 when imaging children with urolithiasis [9]. A more recent paper has shown that up to 87% of paediatric emergency admissions with suspected urolithiasis were imaged with CT [12]. Yet the same authors recommend an increased use of ultrasound to avoid the radiation exposure and potential cancer risk encountered as a result of CT scanning [12].…”

Bildgebende Diagnostik bei Harnsteinen

“…Kritisch betrachtet hat die hohe Sensitivität und Spezifität der NCCT zu einer deutlichen Zunahme der CT-Untersuchungen bei Kindern geführt, so dass in den USA die CT bei Kindern mittlerweile die häu-figste Primärdiagnostik bei Verdacht auf eine Urolithiasis ist. Besorgniserregend aus europäischer Sicht ist, dass rund 87% der Patienten keine vorherige Sonographie erhielten [18]. Die Gefährlichkeit dieses Trends konnte eine australische Groß-felduntersuchung mit einer Kohorte von 680.000 Patienten, die alle im Kindesalter eine CT erhielten, zeigen: die Karzinominzidenz war um 24% erhöht und steigerte sich bei repetitiven Untersuchungen auf >50% [25].…”

Optimizing Diagnostic Imaging in the Emergency Department

“…5 Likewise, the Nationwide Emergency Department Sample and the State Emergency Department Databases are available as part of the Healthcare Cost and Utilization Project and have been used for analyses of imaging practices. 45,73 In addition, the Dose Index Registry is a relatively new registry from the American College of Radiology-sponsored National Radiology Data Registry (www.nrdr.acr.org) and collects anonymized data from CT studies completed at participating institutions in the United States. 74 Data continue to emerge from this resource and a recent study characterized radiation dose indexes for renal colic protocol CTs performed in the United States.…”