Variation in Computed Tomography Imaging for Pediatric Injury-Related Emergency Visits

Abstract

Objectives To assess variation in the use of computed tomography (CT) for pediatric injury-related emergency department (ED) visits. Study design Retrospective cohort study of visits to 14 network-affiliated EDs from November 2010 through February 2013. Visits were identified by International Classification of Diseases, 9th revision, Clinical Modification diagnosis codes. Primary outcome was CT use. We used descriptive statistics and performed multivariable logistic regression to evaluate the association of patient and ED covariates on any and body region-specific CT use. Results Of the 80,868 injury-related visits, 11.4% included CT, and 28.4% of those had more than one study. Across EDs, CT use ranged from 7.6%- 25.5% of visits and did not correlate with institutional injury severity score (P=0.33) or admission/transfer rates (P=0.07). In multivariable analysis of non-pediatric EDs, trauma centers and non-academic EDs were associated with CT use. Higher pediatric volume was associated with any CT use, however, there was an inverse relationship between volume and non-head CT use. When the pediatric ED was included in multivariable modeling, the effect of level 1-3 trauma center designation remained, and the pediatric level 1 trauma center was less likely to use most body region-specific CTs. Conclusions There is wide variation in CT imaging for pediatric injury-related visits not solely attributable to case mix. Future work to optimize CT utilization should focus on additional factors contributing to imaging practices and interventions.

Overuse of CT and MRI in paediatric emergency departments

“…17 Another study estimated higher odds for CT ordering rates during injury related visits in non-paediatric trauma centres and non-academic EDs. 48 Similar results are exhibited in a survey conducted by Wylie et al Paediatric training and higher paediatric volumes were associated with less frequent use of head CT, and community hospital practice was associated with frequent CT use. 10 The typical injury pattern in children is usually confined to an isolated anatomical area rather than multiple sites; hence, the British RCR paediatric trauma guidelines advocate judicious use of targeted CT with relevant paediatric protocols.…”

“…Marin et al 48 Non-academic non-paediatric EDs had higher odds of using any type of CT during injury-related visits [OR = 1.51, 95% CI (1.16 to 1.96)].…”

Hospital Variation in Cervical Spine Imaging of Young Children With Traumatic Brain Injury

“…Indeed, a study of 14 hospitals found increased pediatric volume was associated with decreased performance of cervical CTs in injured children. 13 …”

Executive Summary: The 2018 Academic Emergency Medicine Consensus Conference: Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps

“…There are data to suggest an association between hospital type and pediatric mortality for critically ill children, even though this outcome measure is confounded by overall low pediatric mortality rates . The evidence for substantial variability among EDs in the rates of computed tomographic imaging in pediatric trauma and children with abdominal pain is more robust. While the clinical outcomes are comparable between general and pediatric EDs, the rates of unnecessary exposure to ionizing radiation are different and constitute a higher risk to children in the general ED setting.…”