Trends in Use of Advanced Imaging in Pediatric Emergency Departments, 2009-2018

Abstract

IMPORTANCEThere is increased awareness of radiation risks from computed tomography (CT) in pediatric patients. In emergency departments (EDs), evidence-based guidelines, improvements in imaging technology, and availability of nonradiating modalities have potentially reduced CT use. OBJECTIVE To evaluate changes over time and hospital variation in advanced imaging use.

Emergency pediatric radiology imaging trends for non-COVID-19-related illnesses through different stages of the pandemic

“…In the years prior to the pandemic, rates of advanced imaging increased at our institution, consistent with published trends across other pediatric emergency departments [ 25 ]. During the pandemic, imaging volumes for our pediatric ED decreased significantly, particularly when compared to predicted volumes based on increasing trends.…”

Replacing Computed Tomography with “Rapid” Magnetic Resonance Imaging for Ventricular Shunt Imaging

“…It is important to understand these findings in the context of national data. A recent study of 32 pediatric EDs found a 28% rate of MRI for ventricular shunt evaluation in 2018, 21 well below that during our intervention period, which supports our intervention’s impact.…”

Racial and Ethnic Differences in Emergency Department Diagnostic Imaging at US Children’s Hospitals, 2016-2019

“…Specifically, we evaluated patient age and sex, 22 insurance, 23 time and day of visit, 22 , 24 household income, 25 , 26 distance from the hospital, 27 complex chronic conditions, 26 3-day revisit, 28 , 29 hospitalization (including intensive care unit admission), 26 visit diagnosis, 13 and year. 6 We stratified patient age into clinically meaningful categories (<1, 1-4, 5-12, and 13-17 years) and defined the visit day as weekend vs weekday and arrival time as daytime (8:00 am to 3:59 pm ), evening (4:00 to 11:59 pm ), or overnight (12:00 to 7:59 am ). 30 Median neighborhood household income, presented as quartiles, was based on patient home 5-digit zip code in the PHIS and mapped to the American Community Survey 5-year data for 2014 to 2018.…”

“…However, for patients who are admitted from the ED, the data source does not distinguish between imaging performed in the ED and imaging performed as an inpatient on the same date. Therefore, and in keeping with prior work, 6,18 we defined imaging for admitted patients as follows: if ED arrival time was before 6 PM, we attributed imaging to the ED if it occurred on the day JAMA Network Open | Pediatrics of arrival; if ED arrival time was after 6 PM, we attributed imaging to the ED if it occurred on the day of arrival or the next day.…”

“…In particular, radiologic imaging for pediatric patients is commonly used in the emergency department (ED) setting, with one-third of all visits including at least 1 imaging study. 2 In addition to the many benefits, imaging also carries risks and considerations regarding resource use, including radiation exposure, 3 incidental findings leading to follow-up visits and testing, 4 increased ED length of stay, 5 , 6 and cost. 7 Therefore, differential use of imaging studies across racial and ethnic groups suggests that worse care is being delivered to 1 or more groups.…”