Rising Use of CT in Child Visits to the Emergency Department in the United States, 1995–2008

Larson, David B.; Johnson, Lara; Schnell, Beverly; Goske, Marilyn J.; Salisbury, Shelia; Forman, Howard P.

doi:10.1148/radiol.11101939

Cited by 235 publications

(137 citation statements)

References 36 publications

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“…Our results are similar to other studies examining use trends of various imaging modalities in EDs. 15,16 A NHAMCS study of use trends for computed tomography imaging in children seen in EDs found a fivefold increase from 1995 to 2008; 89.4% of the increased use took place at non-pediatric-focused facilities. 15 What accounts for our observations in the ED use of radiographs for asthma?…”

Section: Discussionmentioning

confidence: 99%

“…15,16 A NHAMCS study of use trends for computed tomography imaging in children seen in EDs found a fivefold increase from 1995 to 2008; 89.4% of the increased use took place at non-pediatric-focused facilities. 15 What accounts for our observations in the ED use of radiographs for asthma? A review of changes in the National Asthma Education and Prevention Program guidelines from 1991 onward did not account for the trend.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, we computed a hospital-related variable "pediatric-focused ED" if .80% of visits to the ED were by children ,18 years of age. A number of methods have been used to compute a pediatricfocused ED or a children' s hospital ED variable, including mean patient age 15 and percentage of visits based on a defined pediatric age group. 16 The definition of our variable is consistent with this methodology and consistent with our previous work.…”

Section: Data Sourcesmentioning

confidence: 99%

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Variation and Trends in ED Use of Radiographs for Asthma, Bronchiolitis, and Croup in Children

2013

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WHAT'S KNOWN ON THIS SUBJECT: Variation in the emergency department (ED) use of radiographs for asthma, bronchiolitis, and croup exists. Unnecessary radiographs contribute to higher costs of care, decreased ED efficiency, and increased radiation in children.WHAT THIS STUDY ADDS: Despite no changes in guidelines to support routine use, there is a significant upward trend in the use of radiographs for children with emergency department visits for asthma. Pediatric-focused EDs use significantly fewer radiographs for asthma, bronchiolitis, and croup. abstract OBJECTIVES: The objectives were (1) to determine trends in radiograph use in emergency department (ED) care of children with asthma, bronchiolitis, and croup; and (2) to examine the association of patient and hospital factors with variation in radiograph use.METHODS: A retrospective, cross-sectional study of National Hospital Ambulatory Medical Care Survey data between 1995 and 2009 on radiograph use at ED visits in children aged 2 to 18 years with asthma, aged 3 months to 1 year with bronchiolitis, and aged 3 months to 6 years with croup. Odds ratios (ORs) were calculated and adjusted for all factors studied. RESULTS:The use of radiographs for asthma increased significantly over time (OR: 1.06; 95% confidence interval [CI]: 1.03-1.09; P , .001 for trend) but were unchanged for bronchiolitis and croup. Pediatric-focused EDs had lower use for asthma (OR: 0.44; 95% CI: 0.29-0.68), bronchiolitis (OR: 0.37; 95% CI: 0.23-0.59), and croup (OR: 0.34; 95% CI: 0.17-0.68). Compared with the Northeast region, the Midwest and South had statistically higher use of radiographs for all 3 conditions. The Western region had higher use only for asthma (OR: 1.67; 95% CI: 1.07-2.60), and bronchiolitis (OR: 2.94; 95% CI: 1. 48-5.87). No associations were seen for metropolitan statistical area or hospital ownership status. CONCLUSIONS:The ED use of radiographs for children with asthma increased significantly from 1995 to 2009. Reversing this trend could result in substantial cost savings and reduced radiation. Pediatricfocused EDs used significantly fewer radiographs for asthma, bronchiolitis, and croup. The translation of practices from pediatricfocused EDs to all EDs could improve performance. Pediatrics 2013;132:245-252 AUTHORS:

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Data Sourcesmentioning

confidence: 99%

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Variation and Trends in ED Use of Radiographs for Asthma, Bronchiolitis, and Croup in Children

2013

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“…19 TS-höfuð var algengasta rannsóknin á Landspítala (40,3%) en þó var hlutfall TS-rannsókna af höfði laegra þar en víða annars staðar. 13,15 Mikil notkun TS vegna höfuðáverka barna 20 hefur leitt til þess að gerðar hafa verið klínískar leiðbeiningar 21 meðal annars á íslensku, 22 sem án efa stuðla að viðeigandi notkun. Það er hins vegar viðurkennt vandamál í Evrópu að leiðbeiningar fyrir tilvísandi laekna vantar víða 15 og fáar leiðbeiningar um val myndrannsókna eru til á íslensku.…”

Section: Umraeðaunclassified

Geislaálag barna í tölvusneiðmyndum á Íslandi

Guðjónsdóttir

Jonsdottir

2017

LBL

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InngangurStór hluti geislaálags vegna laeknisfraeðilegrar myndgreiningar er tilkominn vegna tölvusneiðmyndarannsókna. 1 Sú staðreynd ásamt því að sífellt baetast við taekninýjungar sem geta minnkað geislaálag sjúklings gera það að verkum að mikilvaegt er að fylgjast vel með geislaálagi sjúklinga í tölvusneiðmyndarannsóknum. Þekkt er að það getur verið mikill munur á geislaálagi frá einum stað til annars. 2 Viðmið lengdargeislunar (mGy·cm) í tölvusneið-myndarannsóknum hafa víða verið sett og tilgangurinn með þeim er að stuðla að bestun rannsókna. Valin er tala naerri þriðja fjórð-ungsmarki, byggt á söfnun gagna frá viðkomandi svaeði sem eru nógu umfangsmikil til að endurspegla venjulega notkun. Þeir sem eru yfir viðmiðinu eru hvattir til að leita orsaka þess og leiða til úrbóta. 3 Öll TS-taeki skrá lengdargeislun rannsókna og þá staerð má nota til að áaetla meðalgeislaálag vegna rannsókna. 4,5 Geislaálag barna er sérstaklega mikilvaegt vegna þess að áhaetta barna vegna geislunar er meiri en fullorðinna, baeði vegna þess að þau eru viðkvaemari fyrir geislun en fullorðnir og líkurnar á að skaðar geti komið fram síðar eru meiri þar sem þau eiga að jafnaði lengra líf fyrir höndum. 6 Markmið þessarar rannsóknar var að meta geislaálag barna í tölvusneiðmyndum á Íslandi.Inngangur: Það er mikilvaegt að þekkja geislaálag sjúklinga vegna tölvu-sneiðmyndarannsókna (TS) og markmið þessarar rannsóknar var að meta geislaálag barna í TS á Íslandi. Efniviður og aðferðir: Allar TS af börnum (yngri en 18 ára) á Landspítala á tímabilinu 1. febrúar 2016 til 1. febrúar 2017 voru skoðaðar í myndageymslu og aldur barns, tegund rannsóknar og heildar lengdargeislun skráð. Einnig var heildarfjöldi TS kannaður. Hlutfall rannsókna af börnum var reiknað, tíðni mismunandi rannsókna og fyrir þrjár þaer algengustu var meðaltal lengdargeislunar reiknað og meðalgeislaálag áaetlað fyrir 5 aldurshópa. Niðurstöður: Á tímabilinu voru gerðar 662 TS af börnum, eða 3,6% af heildarfjölda. Þrjár algengustu rannsóknirnar voru af höfði (40,3%), kvið (15,6%) og brjóstholi (10,3%). Meðalgeislaálag þessara þriggja rannsókna var, í sömu röð, fyrir börn yngri en fjögurra mánaða: 5,3/4,9/3,0 mSv; fjögurra mánaða til yngri en þriggja ára: 4,2/5,5/1,9 mSv; þriggja ára til yngri en átta ára: 2,7/ 3,4/1,0 mSv; átta ára til yngri en 15 ára: 3,2/4,4/1,0 mSv og 15 ára til yngri en 18 ára: 2,1/6,5/3,3 mSv. Meðaltal lengdargeislunar var í flestum tilvikum yfir evrópskum viðmiðunarmörkum. Ályktun: Vert er að kanna hvort haegt er að minnka geislaálag barna í TS og beina aetti sjónum að staerðarleiðréttum geislaskammti í slíkri vinnu. Ástaeða er til að aetla að aukið eigið eftirlit með geislaskömmtum myndi skila sér í jafnari gaeðum og minna geislaálagi.

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“…The percentage of emergency department visits for head trauma resulting in CT examinations rose steadily from 12% in 1997 to 34% in 2008. 2 Increased awareness of the potential long-term hazards of radiation, particularly in children, [3][4][5] has engaged physicians and regulators in attempts to decrease CT use without compromising patient care. 6,7 In August 2001, a multidisciplinary group, including 40 pediatric radiologists, gathered for the ALARA conference.…”

mentioning

confidence: 99%

CT for Pediatric, Acute, Minor Head Trauma: Clinician Conformity to Published Guidelines

Linscott

Kessler

Kitchin

et al. 2012

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:In 2001, pediatric radiologists participating in a panel discussion on CT dose reduction suggested that approximately 30% of head CT examinations were performed unnecessarily. With increasing concern regarding radiation exposure to children and imaging costs, this claim warrants objective study. The purpose of this study was to test the null hypothesis that 30% of head CT studies for clinical evaluation of children with acute, minor head trauma do not follow established clinical guidelines.

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Rising Use of CT in Child Visits to the Emergency Department in the United States, 1995–2008

Abstract: Use of CT in children who visit the ED has increased substantially and occurs primarily at non-pediatric-focused facilities. This underscores the need for special attention to this vulnerable population to ensure that imaging is appropriately ordered, performed, and interpreted.

Cited by 235 publications

References 36 publications

Variation and Trends in ED Use of Radiographs for Asthma, Bronchiolitis, and Croup in Children

Variation and Trends in ED Use of Radiographs for Asthma, Bronchiolitis, and Croup in Children

Geislaálag barna í tölvusneiðmyndum á Íslandi

CT for Pediatric, Acute, Minor Head Trauma: Clinician Conformity to Published Guidelines

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