CT use for pediatric falls doubled over 10-year span

The rate of CT scans performed on pediatric fall patients increased twofold from 2001-2010, suggesting overutilization of the modality and unnecessary patient exposure to radiation, according to study results published in the July issue of Academic Radiology.

Overall, a number of studies have shown that CT imaging spiked in the mid-2000s before growth plateaued in the late 2000s. This same pattern is reflected in the study of pediatric fall patients, which showed CT utilization rates peaking in 2009, before dipping the following year, according to Varun Shahi, and his colleagues at the Mayo Clinic in Rochester, Minn.

Still, even with the growth trends slowing, it's important to closely monitor the use of imaging in pediatric populations. Utilization of CT grew rapidly in emergency departments nationwide due to increased availability, quick imaging results and enhanced diagnostic capabilities. But those scans—at least 4 million of which are performed on children every year in the U.S. alone—can lead to excessive healthcare spending and potentially negative effects on the health of pediatric patients. “Recent studies indicate that nearly a quarter of all CTs ordered are inappropriate, thus subjecting patients to unnecessary radiation exposure,” wrote Shahi and colleagues. “This is particularly concerning in the pediatric population, placing them at a potential risk for cancer, a risk that is cumulative over the patient’s lifetime.”

Shahi and his team set out to evaluate trends in pediatric CT utilization in patients presenting to the ED after a fall. To do so, they used the National Hospital Ambulatory Medical Care Survey to identify all pediatric emergency room visits resulting from falls from 2001-2010, then analyzed how often those visits involved life-threatening conditions and with what frequency CT examinations were performed. The relationship between CT utilization and demographic and admission status was also investigated.

Their results showed that the proportion of pediatric fall patients receiving CT spiked from 5 percent in 2001 to 17 percent in 2009, before dropping to 11 percent in 2010. During the same time period, the number of pediatric fall patients with life-threatening conditions fluctuated between 1 and 3 percent. The researchers also found that children between 0-1 years of age are most likely to undergo CT scans following a fall, while teens aged 13-17 were the group least likely to have CT ordered for fall-related injuries.

“CT utilization among pediatric fall patients doubled between 2001 and 2010, although the prevalence of life-threatening conditions remained relatively stabl,” wrote Shahi and colleagues. “Further work is necessary to uncover the factors that ultimately contribute to the utilization of CTs in the pediatric ER. This may begin with physician education on the risks of CT utilization to prevent unnecessary scans from taking place.”