Variation in low-value radiograph use for children in the emergency department: a cross-sectional study of administrative databases

Abstract

CMAJ OPEN, 10(4) E889"L ow-value care" describes medical interventions that do not have additional benefit when compared with a less costly alternative. 1,2 Decreasing "low-value care" has been identified as a priority to reduce wait times, patient exposure to harm and anxiety, and unnecessary costs. 1,2 Diagnostic imaging is a major contributor to low-value care in the emergency department (ED), [3][4][5] and accounts for 6 of 10 Choosing Wisely recommendations for emergency phys icians in Canada (https://choosingwiselycanada.org/recommendation/ emergency-medicine/). Low-value diagnostic imaging is a particularly important issue for pediatric patients, who are at increased risk of harm because of their increased susceptibility to ionizing radiation 6 and the harms related to unnecessary treatments associated with diagnostic imaging use. 7,8 One particular area for improvement is the use of low-value radiographs for common pediatric conditions that present to the ED. Multiple clinical practice guidelines recommend against routine radiograph use for bronchiolitis, 9-15 asthma, 12,13,16-18 abdominal

Comparison of a Rapid Multiplex Gastrointestinal Panel with Standard Laboratory Testing in the Management of Children with Hematochezia in a Pediatric Emergency Department: Randomized Controlled Trial

“…As this study was conducted in a pediatric tertiary-care ED, guideline adherence may have been greater than occurs in nonpediatric tertiary-care centers. For example, low-value radiograph use is more commonly requested by emergency medicine physicians practicing in EDs that primarily treat adult patients ( 28 ).…”