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Computed tomography use among children presenting to emergency departments with abdominal pain
Jahan Fahimi1, Andrew Herring, Aaron Harries
1Department of Emergency Medicine, Alameda County Medical Center-Highland Hospital, 1411 E 31st St, Oakland, CA 94602, USA. jahan.fahimi@ucsf.edu
Insights
Computed tomography (CT) use for pediatric emergency department visits for abdominal pain dramatically increased from 1998 to 2008. Factors like age, sex, and race influenced CT scan likelihood, with disparities noted.
Area of Science:
- Pediatric Emergency Medicine
- Radiology and Imaging
- Health Services Research
Background:
- Abdominal pain is a common reason for pediatric emergency department (ED) visits.
- The utilization of advanced imaging, such as computed tomography (CT), has evolved over time.
- Understanding trends and disparities in CT use is crucial for appropriate pediatric care.
Purpose of the Study:
- To evaluate trends in computed tomography (CT) utilization for children with abdominal pain in the ED.
- To identify factors associated with CT scan use in this pediatric population.
Main Methods:
- Cross-sectional, secondary analysis of the National Hospital Ambulatory Medical Care Survey (1998-2008).
- Identified pediatric patients (<19 years) presenting to the ED with abdominal pain.
- Multivariate regression analysis to determine factors associated with CT use.
Main Results:
- CT use for pediatric abdominal pain ED visits rose from 0.9% (1998) to 15.4% (2008).
- Older, male, and admitted children were more likely to receive CT scans.
- Black children were less likely to undergo CT scans compared to white children.
Conclusions:
- CT imaging utilization significantly increased in pediatric EDs for abdominal pain evaluations.
- Disparities in CT scan likelihood exist among different pediatric demographic groups.
- Further research is needed to address potential inequities in imaging practices.
Objective:
To evaluate trends in and factors associated with computed tomography (CT) use among children presenting to the emergency department (ED) with abdominal pain.
Methods:
This study was a cross-sectional, secondary analysis of the National Hospital Ambulatory Medical Care Survey data from 1998 to 2008. We identified ED patients aged <19 years with abdominal pain and collected patient demographic and hospital characteristics, and outcomes related to imaging, hospital admission, and diagnosis of appendicitis. Trend analysis was performed over the study period for the outcomes of interest, and a multivariate regression model was used to identify factors associated with CT use.
Results:
Of all pediatric ED visits, 6.0% were for abdominal pain. We noted a rise in the proportion of these patients with CT use, from 0.9% in 1998 to 15.4% in 2008 (P < .001), with no change in ultrasound/radiograph use, diagnosis of appendicitis, or hospital admission. Older and male patients were more likely to have a CT scan, whereas black children were one-half as likely to undergo a CT scan compared with white children (odds ratio: 0.50 [95% confidence interval: 0.31-0.81]). Admitted children had much higher odds of undergoing a CT scan (odds ratio: 4.11 [95% confidence interval: 2.66-6.35]). There was a plateau in CT use in 2006 to 2008.
Conclusions:
There was a dramatic increase in the utilization of CT imaging in the ED evaluation of pediatric patients with abdominal pain. Some groups of children may have a differential likelihood of receiving CT scans.
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