News | April 24, 2012

Study Shows Increase in Emergency CTs of Children

April 24, 2012 — Computed tomography (CT) utilization in pediatric patients with non-traumatic abdominal pain increased in emergency departments each year between 1999 and 2007, according to a new study published online in the journal Radiology. The study’s authors found no corresponding increase in ultrasound use during the same period, despite research supporting it as an important diagnostic tool for assessing pediatric abdominal pain.

Non-traumatic abdominal pain is a common source of pediatric visits to the emergency department. Physicians often order CT exams when abdominal pain suggests appendicitis. While CT scans provide rapid, accurate diagnosis, they expose patients to ionizing radiation—an important consideration for children due to their longer life expectancy and increased susceptibility to radiation effects.

“Our findings help give us an overall understanding of places where we can tackle disparities of use and disparities in care,” said Anastasia L. Hryhorczuk, M.D., clinical fellow at Children’s Hospital Boston. “Ideally, we'd like to see the same standard of care being applied across the country to protect children from unnecessary radiation exposure.”

Research has shown that step-by-step evaluations of pediatric patients, beginning with ultrasound and proceeding to CT if ultrasound is negative or uncertain, is the most accurate path for diagnosing appendicitis. Hryhorczuk and colleagues sought to determine if this strategy had been incorporated into general emergency department practices.

For the study, researchers looked at data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) to evaluate imaging utilization among children with acute abdominal pain in U.S. emergency departments. From 1999 to 2007, there were 16,900,000 pediatric emergency department visits for acute abdominal pain. The odds of a child receiving a CT scan increased during each year of the study period, despite the fact that there were no statistically significant changes in ultrasound usage, numbers of patients admitted to the hospital or numbers of patients with acute appendicitis. Only three percent of patients ultimately diagnosed with appendicitis were imaged with both ultrasound and CT.

Children evaluated in pediatric emergency departments were more than 25 percent less likely than those seen at general emergency departments to undergo CT imaging for abdominal pain. “In a pediatric setting, clinicians may have skills for evaluating patients that favor management without imaging, lowering CT usage,” Hryhorczuk said.

Statistical analysis demonstrated increased odds of CT use in teens, white patients, the Midwest region, urban settings, patients with private insurance, and patients who were admitted or transferred.

Although the study did not investigate reasons for these variations, Hryhorczuk pointed out that CT scanners are readily available in hospitals, whereas access to ultrasound may be limited based on operator availability in some areas. The local legal climate also may play a factor in obtaining imaging exams, according to the study, as appendicitis diagnoses are a source of lawsuits in the pediatric emergency setting.

The time period of the study predates “Image Gently,” a 2008 initiative of the Alliance for Radiation Safety in Pediatric Imaging that promotes radiation safety in the imaging of children. The researchers hope that further investigation of NHAMCS data will provide more information on the success of this and other programs aimed at lowering medical radiation exposure in children.

For more information: http://radiology.rsna.org

Related Content

New Study Redefines Therapeutic Dose Guidelines for Non-Small Cell Lung Cancer
News | Lung Cancer | April 23, 2019
Non-small cell lung cancer is a common cancer for both men and women. Many people who are diagnosed with this type of...
Comparison of state Medicaid fees for radiation oncology services for breast cancer and nonradiation oncology services per the Kaiser Family Foundation Index

Fig. 1: Comparison of state Medicaid fees for radiation oncology services for breast cancer and nonradiation oncology services per the Kaiser Family Foundation Index. (Agarwal et al, Red Journal, 2019) Credit: Elsevier

News | Radiation Therapy | April 22, 2019
April 22, 2019 — A new study finds wide state
Stereotactic Radiosurgery Effective for Pediatric Arteriovenous Malformation Patients
News | Radiation Therapy | April 19, 2019
Ching-Jen Chen, M.D., of the neurosurgery department at the University of Virginia (UVA) Health System, was the winner...
Video Plus Brochure Helps Patients Make Lung Cancer Scan Decision

Image courtesy of the American Thoracic Society

News | Lung Cancer | April 19, 2019
A short video describing the potential benefits and risks of low-dose computed tomography (CT) screening for lung...
FDA Clears GE's Deep Learning Image Reconstruction Engine
Technology | Computed Tomography (CT) | April 19, 2019
GE Healthcare has received 510(k) clearance from the U.S. Food and Drug Administration (FDA) of its Deep Learning Image...
Surgically Guided Brachytherapy Improves Outcomes for Intracranial Neoplasms
News | Brachytherapy Systems | April 18, 2019
Peter Nakaji, M.D., FAANS, general practice neurosurgeon at Barrow Neurological Institute, presented new research on...
Check-Cap Initiates U.S. Pilot Study of C-Scan for Colorectal Cancer Screening
News | Colonoscopy Systems | April 15, 2019
Check-Cap Ltd. has initiated its U.S. pilot study of the C-Scan system for prevention of colorectal cancer through...
Deep Lens Closes Series A Financing for Digital AI Pathology Platform
News | Digital Pathology | April 09, 2019
Digital pathology company Deep Lens Inc. announced the closing of a $14 million Series A financing that will further...
Uterine Fibroid Embolization Safer and as Effective as Surgical Treatment
News | Interventional Radiology | April 05, 2019
Uterine fibroid embolization (UFE) effectively treats uterine fibroids with fewer post-procedure complications compared...
Videos | RSNA | April 03, 2019
ITN Editor Dave Fornell takes a tour of some of the most interesting new medical imaging technologies displa