Pediatric CT utilization in the emergency department (ED) peaked in 2008, and dropped from 2008 to 2010, according to a study published online Feb. 13 in Pediatrics.
Researchers suggested that the decline may be related to increased awareness of radiation risks. Studies have shown large increases in adult CT usage as well as increasing pediatric usage from 2000 to 2006. Given the heightened awareness of radiation risks among children in the last decade, Margaret J.A. Menoch, MD, of the department of pediatrics at Emory University School of Medicine in Atlanta, and colleagues hypothesized that use of CT in pediatric EDs may have dropped, particularly for indications such as seizures where the literature recommends minimized imaging.
Menoch et al conducted a retrospective chart review at two tertiary care pediatric EDs, analyzing utilization by anatomic location for studies acquired from January 2003 to December 2010. The researchers also compared annual CT utilization rates with alternative imaging trends for visits with chief complaints of head injury, abdominal pain, seizure and possible ventriculoperitoneal shunt problem.
Although Menoch and colleagues found no change in overall CT utilization or use within anatomic subgroups from 2003 to 2010, the researchers reported an increase in alternative, non-ionizing radiation modalities when such exams were options.
The analysis included 987,032 ED visits. CT imaging was performed in 5.5 percent of the visits, with head CTs accounting for 63 percent of exams, abdomen/pelvis CTs 20 percent, cervical spine 3 percent and 14 percent as other.
Although there was no decline in abdominal CT for the indication of abdominal pain, the rate of abdominal ultrasound increased, according to the researchers.
Menoch et al also noted “statistically significant downward trends in the rate of head CTs within the chief complaint of head injury and seizure,” and suggested that the drop may be attributed to awareness of radiation risks, with providers substituting observation for CT exams. The shift could account for the increase in admission rates of children presenting with seizures.
“In these cases, there may be an increase in overall healthcare utilization if the period of hospitalization or extended observation exceeds the cost of the deferred CT scan,” Menoch and colleagues wrote.
The researchers suggested a combination of factors contributed to CT utilization trends: provider and parental recognition of radiation risks, studies guiding CT utilization and awareness of alternative non-ionizing modalities, and emphasized the importance of ongoing analysis of trends in CT utilization and causality.