Radiology: Pediatric CT spikes 5-fold in U.S. EDs

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CT utilization in EDs across the country is surging in pediatric patients; whereas 1.2 percent of children admitted to the ED received CT scans in 1995, that percentage grew to nearly 6 percent by 2008, leading the authors of a study published April 5 in Radiology to reiterate calls for close scrutiny of CT use, especially among children.
With CT constituting the largest source of medical-related radiation in the U.S., studies relating the increasing utilization of the imaging modality have turned the heads of payors, regulators and physicians alike. Although some studies have likewise found large increases among pediatrics, most have been smaller or single-institution studies.

The authors sought to determine the change in CT use among pediatric ED visits between 1995 and 2008. Using the National Hospital Ambulatory Medical Care Survey (NHAMCS), the authors sampled a mean of 7,375 visits from all parts of the U.S., in both dedicated pediatric departments and general EDs.

The number of pediatric ED visits that included a CT increased from 0.33 million in 1995 to 1.65 million in 2008, a fivefold increase. As a percentage of all pediatric visits, those including CT accounted for 1.2 percent at the start of the study and 5.9 percent in 2008.

Little difference was observed in utilization and growth between patients of different sexes or races, although age appeared to be a significant determinant of utilization. Children aged six years and older experienced significantly higher likelihoods of receiving CTs, and those numbers grew more rapidly than amongst their younger counterparts.

The chief complaints for which CT was utilized were head injury, headache and abdominal pain. Abdominal scans grew the most rapidly, from usage in under 2 percent of visits in the late 1990s to between 15 and 21 percent of visits in the mid- to late-2000s. The authors expressed concern over this last point, given that abdominal and pelvic CT exposes patients to up to seven times the radiation dose of CTs of the head.

The authors noted that pediatric CT’s compound annual growth rate of 12.8 percent was comparable to the growth seen among adults, which the authors cited at 14.2 percent. “The growth in the use of CT is explained by increasing frequency of use, not by an increase in the number of pediatric visits to the ED, because the number of pediatric visits remained relatively constant during the study period,” explained David B. Larson, MD, MBA, from the department of radiology at Cincinnati Children’s Hospital and colleagues.

Larson and co-authors also found that CT use was more common at non-pediatric-focused EDs, although pediatric facilities showed greater increases in usage of the modality. Highlighting the need for appropriate use, the authors noted that it “is possible that non-pediatric-focused radiology departments may be less likely to consistently tailor the CT technique to the body size of the pediatric patient.”

With children’s higher sensitivity to radiation and longer lifespans in which to acquire toxicity, Larson and colleagues stressed the importance of tailoring dose protocols to pediatric patients.

“It is the professional obligation of all radiologists who perform pediatric CT to invest the required time and effort in developing the expertise to ensure that this [optimization of dose] occurs consistently for children,” the authors noted. They concluded by calling for “collaborative approaches that align pediatric radiology departments and EDs with general radiology departments and EDs” to ensure that general EDs, in which the majority of pediatric CTs occur, attentively adjust dose according to patient size and age.