Overuse of CT and MRI in paediatric emergency departments

Ohana, Orly; Soffer, Shelly; Zimlichman, Eyal; Klang, Eyal

doi:10.1259/bjr.20170434

Cited by 76 publications

(87 citation statements)

References 91 publications

(158 reference statements)

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“…Recent studies have found that MRI use in the ED has increased over time and the majority of centers with a neurosurgeon on staff have the ability to obtain MRI in ED patients. 13,14 An additional consideration for practical use is the time it takes to get an MRI as well as the ability of a child to tolerate the test. Our study found that ∼1% of patients needed some form of anxiolysis to complete the qbMRI.…”

Section: Discussionmentioning

confidence: 99%

Can QuickBrain MRI replace CT as first‐line imaging for select pediatric head trauma?

et al. 2020

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Objective The current standard of care for initial neuroimaging in injured pediatric patients suspected of having traumatic brain injury is computed tomography (CT) that carries risks associated with radiation exposure. The primary objective of this trial was to evaluate the ability of a QuickBrain MRI (qbMRI) protocol to detect clinically important traumatic brain injuries in the emergency department (ED). The secondary objective of this trial was to compare qbMRI to CT in identifying radiographic traumatic brain injury. Methods This was a prospective study of trauma patients less than 15 years of age with suspected traumatic brain injury at a level 1 pediatric trauma center in Portland, Oregon between August 2017 and March 2019. All patients in whom a head CT was deemed clinically necessary were approached for enrollment to also obtain a qbMRI in the acute setting. Clinically important traumatic brain injury was defined as the need for neurological surgery procedure, intubation, pediatric intensive care unit stay greater than 24 hours, a total hospital length of stay greater than 48 hours, or death. Results A total of 73 patients underwent both CT and qbMRI. The median age was 4 years (interquartile range [IQR] = 1–10 years). Twenty‐two patients (30%) of patients had a clinically important traumatic brain injury, and of those, there were 2 deaths (9.1%). QbMRI acquisition time had a median of 4 minutes and 52 seconds (IQR = 3 minutes 49 seconds–5 minutes 47 seconds). QbMRI had sensitivity for detecting clinically important traumatic brain injury of 95% (95% confidence interval [CI] = 77%–99%). For any radiographic injury, qbMRI had a sensitivity of 89% (95% CI = 78%–94%). Conclusion Our results suggest that qbMRI has good sensitivity to detect clinically important traumatic brain injuries. Further multi‐institutional, prospective trials are warranted to either support or refute these findings.

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Section: Discussionmentioning

confidence: 99%

Can QuickBrain MRI replace CT as first‐line imaging for select pediatric head trauma?

et al. 2020

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“…1,2 MRI is costly, not typically feasible in the ED setting, and may require sedation in young children. [8][9][10] While clinical decision tools such as the Pediatric Emergency Care Applied Research Network criteria and the Pediatric Appendicitis Score have aided in decreasing unnecessary imaging in certain pediatric conditions, there are no guidelines or risk-stratification tools to aid emergency physicians in determining the need for additional evaluation in patients presenting with atraumatic torticollis without neurologic deficits. 10 Given the rarity of this diagnosis, the paucity of physical examination findings early in the course, and the risks of unnecessary imaging in pediatric patients, some diagnostic delay may, unfortunately, be inevitable.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10] While clinical decision tools such as the Pediatric Emergency Care Applied Research Network criteria and the Pediatric Appendicitis Score have aided in decreasing unnecessary imaging in certain pediatric conditions, there are no guidelines or risk-stratification tools to aid emergency physicians in determining the need for additional evaluation in patients presenting with atraumatic torticollis without neurologic deficits. 10 Given the rarity of this diagnosis, the paucity of physical examination findings early in the course, and the risks of unnecessary imaging in pediatric patients, some diagnostic delay may, unfortunately, be inevitable. However, such cases serve as a reminder of the importance of considering malignancy in patients presenting with atraumatic torticollis, repeating thorough neurologic examinations with repeated ED presentations, and providing detailed return instructions to parents.…”

Section: Discussionmentioning

confidence: 99%

A Case Report of B-cell Lymphoblastic Leukemia/Lymphoma Presenting as Isolated Torticollis in a 2-year-old Female

Boushra

2020

Clinical Practice and Cases in Emergency Medicine

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Introduction: Malignancy is a rare cause of acquired torticollis in children, and spinal cord involvement from hematolymphoid malignancies is similarly unusual. Neurologic abnormalities may not be present on initial evaluation, and delayed diagnosis and treatment is associated with increased risk of permanent paralysis. Case Report: The author describes a case of isolated torticollis in a 2-year-old evaluated multiple times in the emergency department (ED) and outpatient settings. For her first three presentations, the patient had no associated neurologic abnormalities. She was discharged with return precautions and a presumptive diagnosis of viral infection/lymphadenitis. She later developed weakness of her left arm and was diagnosed with a B-cell lymphoblastic leukemia/lymphoma causing spinal cord compression. Conclusion: This case highlights the importance of continued comprehensive and meticulous physical examination in patients with repeat ED visits, as well as the value of detailed discharge instructions in mitigating diagnostic delays in these patients.

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“…Epidemiologic studies have shown that in utero exposure to radiation is associated with higher incidence of pediatric cancers, but data related to rates of pediatric and adult cancers are relatively scarce [60]. In recent years, CT scanning has become the favored imaging modality in many clinical scenarios and is likely to see even further increases in use going forward [61][62][63]. As such, CT utilization in pediatrics has increased markedly over the last 20 years.…”

Section: Patient Exposure To Radiationmentioning

confidence: 99%

Fundamentals of Medical Radiation Safety: Focus on Reducing Short-Term and Long-Term Harmful Exposures

Alers¹,

Salen²,

Yellapu³

et al. 2019

Vignettes in Patient Safety - Volume 4 [Working Title]

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This chapter provides an overview of key topics in the area of radiation safety. Three clinical vignettes will serve to frame the review of the literature around both diagnostic radiation exposure and the risk of radioisotope contamination. Advancement in medical technology is rarely innocuous, and the use of radiation as both means to diagnose and treat certain conditions is not an exception. It is very important for clinicians to review the basics of harmful medical radiation exposure since, although seldom encountered, treatment, and outcomes are time sensitive. The advent of newer technology and the widespread availability of equipment will only serve to increase the prevalence of potentially harmful medical radiation exposure. Moreover, this chapter aims to explore current multidisciplinary endeavors to provide safe and efficient use of radiation in medicine. Solely relying on the medical profession for development of safeguards against harmful medical radiation exposure would be an impossible task. This is why it is crucial for professionals such as health physicists, radiation safety enforcement officers, and policy-makers at the state, national, and international level to establish consensus guidelines aimed toward safe, reliable utilization of radiation in medicine. Part of this interdisciplinary approach needs to focus on accurate education of patients. A thorough assessment of acute radiation syndrome, including diagnosis, treatment, and prognostic indicators is also part of this chapter. Furthermore, principles of screening for, and protection from, radiation contamination are outlined. Finally, areas for further research are identified throughout the chapter. The discussion takes into account both US-based and International research and practice guidelines.

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Overuse of CT and MRI in paediatric emergency departments

Cited by 76 publications

References 91 publications

Can QuickBrain MRI replace CT as first‐line imaging for select pediatric head trauma?

Can QuickBrain MRI replace CT as first‐line imaging for select pediatric head trauma?

A Case Report of B-cell Lymphoblastic Leukemia/Lymphoma Presenting as Isolated Torticollis in a 2-year-old Female

Fundamentals of Medical Radiation Safety: Focus on Reducing Short-Term and Long-Term Harmful Exposures

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