Has pediatric CT use peaked?

Multiple studies have detailed escalating CT use in the U.S. However, physicians at Harborview Medical Center in Seattle may have tamed CT use among hospitalized pediatric trauma patients, according to a study published online Feb. 25 in Radiology.

Although CT remains the imaging modality of choice for many trauma exams, it has come under fire for its role in rising healthcare costs and for emission of potentially harmful ionizing radiation. Several groups have attempted to curb CT overuse and reduce pediatric radiation dose. However, studies have suggested that pediatric CT use continues to grow, according to Bahman S. Roudsari, MD, PhD, from the department of radiology at University of Washington in Seattle, and colleagues.

Roudsari and colleagues sought to evaluate the 15-year trend in CT use in hospitalized pediatric trauma patients at Harborview Medical Center from 1996 to 2010. They designed a retrospective analysis and focused on 64,425 trauma patients 0 to 54 years of age.

Patients were divided into three age groups: 0 to 14 years, 15 to 18 years and 19 to 54 years. A total of 77 percent of patients were 19 to 54 years old, while 14 percent were 0 to 14 years old and 9 percent were 15 to 18 years old.

The researchers reported that 52 percent of patients 0 to 14 years old had an injury severity score from 0 to 8, compared with 37 percent among patients 15 to 18 years old.

Among trauma patients ages 0 to 14 years old, head CT increased slightly from 2000 to 2004, and then dipped, reaching its lowest point in 2010. Pelvic CT peaked in 2005, and then decreased until 2010, according to the researchers. Abdominal CT followed a pattern similar to pelvic CT.

“These findings are in contrast to those of most recent studies, which have demonstrated escalating trends in the use of CT in different healthcare settings,” Roudsari et al wrote. The researchers offered several possible reasons for the discrepancy, including practice differences and major differences in research methodology, specifically their focus on hospitalized trauma patients.

The generalizability of the findings is limited as the study did not include patients released from the emergency department. The study also did not address appropriateness of the CT exams.

Finally, Roudsari and colleagues added the stable or declining use of CT among hospitalized trauma patients has not been associated with a higher mortality rate at Harborview Medical Center.