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Increasing utilization of computed tomography in the pediatric emergency department, 2000-2006
Joshua Broder1, Lynn Ansley Fordham, David M Warshauer
1Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. brode007@mc.duke.edu
Insights
Pediatric emergency department computed tomography (CT) use surged from 2000-2006, especially in adolescents, outpacing patient volume growth. This trend occurred despite radiation concerns, possibly due to advanced technology and diagnostic certainty demands.
Area of Science:
- Radiology
- Pediatric Emergency Medicine
- Health Services Research
Background:
- Computed tomography (CT) utilization in pediatric emergency departments (EDs) has been a topic of discussion due to radiation risks.
- Trends in CT scan ordering for pediatric patients in the ED require characterization to understand utilization patterns.
Purpose of the Study:
- To analyze changes in computed tomography (CT) utilization across different body regions within a pediatric emergency department (ED) over a six-year period.
- To compare the rate of increase in CT utilization with the growth in pediatric ED patient volume and acuity.
Main Methods:
- Retrospective analysis of CT scans performed on pediatric patients (ages 0-17) in the ED from July 2000 to July 2006.
- Categorization of CT scans into head, cervical spine, chest, abdomen, and miscellaneous groups.
- Determination of pediatric ED patient volume and triage acuity scores for the study period.
Main Results:
- CT utilization increased significantly across all analyzed categories, with the most substantial rises in cervical spine (366%) and chest (435%) scans.
- Overall pediatric ED patient volume increased by 2%, while triage acuity remained stable during the study period.
- Increases in CT utilization were most pronounced in adolescents (13-17 years), mirroring adult trends and exceeding growth in younger children.
Conclusions:
- Pediatric ED CT utilization, particularly in adolescents, has risen dramatically, far exceeding patient volume growth.
- This trend suggests factors like increased CT availability, improved diagnostic capabilities, and a desire for diagnostic certainty may be driving utilization.
- Further research is needed to determine if this increased CT utilization translates to improved patient outcomes, especially considering radiation exposure risks.
Abstract:
The objective of this study is to characterize changes in computed tomography (CT) utilization in the pediatric emergency department (ED) over a 6-year period. CT scans ordered on pediatric (ages 0 to 17 years) ED patients from July 2000 to July 2006 were analyzed in five groups: head, cervical spine, chest, abdomen, and miscellaneous. Pediatric ED patient volume and triage acuity scores were determined. There were 6,073 CT scans performed on 4,138 pediatric patients in the ED during the study period. During this same period, 78,932 pediatric patients were evaluated in the ED. From 2000 to 2006, pediatric ED patient volume increased by 2%, while triage acuity remained stable. During this same period, head CT increased by 23%, cervical spine CT by 366%, chest CT by 435%, abdominal CT by 49%, and miscellaneous CT by 96%. Increases in CT utilization were most pronounced in adolescents ages 13 to 17 years. Increases in CT utilization in this age group met or exceeded increases seen in the adult population. In children less than 13 years of age, increases were substantially smaller. Pediatric ED CT utilization particularly in the adolescent population has increased at a rate far exceeding the growth in ED patient volume, mimicking the adult trend. This increase has occurred despite considerable discussion in the medical literature about the radiation risks of CT in the pediatric population and may reflect increased availability of CT, improvements in CT diagnostic capabilities, and increased desire on the part of physicians and patients for diagnostic certainty. Whether this increased utilization results in improved patient outcomes is uncertain and deserves further study.
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