CT utilization: the emergency department perspective
1Division of Emergency Medicine, Duke University Medical Center, Durham, NC 27713, USA. joshua.broder@duke.edu
Insights
Pediatric CT scan use has surged, raising concerns about radiation exposure and costs. Strategies like improved education, clinical decision rules, and alternative imaging can help reduce unnecessary CT scans in emergency departments.
Area of Science:
- Radiology
- Pediatric Emergency Medicine
Background:
- Computed Tomography (CT) scan utilization in pediatric emergency departments (EDs) has significantly increased.
- This rise is attributed to enhanced diagnostic capabilities and broader availability of CT technology.
- However, increased CT use raises concerns regarding patient radiation exposure and healthcare costs.
Purpose of the Study:
- To review the trends in CT scan utilization within pediatric EDs.
- To examine the driving factors behind the increased use of CT scans in pediatric patients.
- To explore strategies for limiting or reducing CT scan utilization in the future.
Main Methods:
- Review of current literature and data on pediatric CT scan utilization trends.
- Analysis of factors contributing to increased CT use, including technological advancements and clinical practice patterns.
- Identification and evaluation of potential strategies for optimization of CT use.
Main Results:
- CT utilization in pediatric EDs has seen dramatic increases.
- Driving forces include improved diagnostic accuracy, wider availability, and potentially liability concerns.
- Strategies for reduction involve education, clinical decision rules, protocol optimization, alternative imaging (ultrasound, MRI), and clinical observation.
Conclusions:
- Balancing diagnostic needs with radiation safety is crucial in pediatric imaging.
- Implementing a multi-faceted approach involving education, evidence-based guidelines, and alternative modalities can mitigate risks associated with increased CT use.
- Future protocols should prioritize patient safety by minimizing radiation exposure while ensuring timely and accurate diagnoses.
Abstract:
CT scan utilization in the pediatric emergency department (ED) has dramatically increased in recent years. This likely reflects the improved diagnostic capability of CT, as well as its wider availability. However, the utility of CT is tempered by the high radiation exposure to patients as well as cost. In this review we will consider the magnitude of changes in CT use in the pediatric ED, and we will examine some of the driving forces behind these increases. In addition, we will consider strategies to limit growth in CT scan utilization or even result in reductions in CT use in the future. These strategies include better physician and patient education, application of existing clinical decision rules to reduce CT utilization and development of new rules, technical alterations in CT protocols to reduce per-exam exposures, use of alternative imaging modalities such as US and MRI that do not expose patients to ionizing radiation, and expanded use of clinical observation in place of immediate diagnostic imaging. Reform of liability laws might alleviate another driving force behind high CT utilization rates. Protocols must be designed to maximize patient safety by limiting radiation exposures while preserving rapid and accurate diagnosis of time-sensitive conditions.
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