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Nationwide emergency department imaging practices for pediatric urolithiasis: room for improvement
Emilie K Johnson1, Dionne A Graham2, Jeanne S Chow3
1Department of Urology, Boston Children's Hospital, Boston, Massachusetts.
Insights
Computed tomography (CT) is frequently used for pediatric urolithiasis, despite risks. Ultrasound is underutilized in emergency departments, even those serving more children. Alternatives to CT warrant consideration.
Area of Science:
- Pediatric Emergency Medicine
- Medical Imaging
- Urology
Background:
- Children with urolithiasis may require repeated imaging.
- Medical radiation poses significant risks to pediatric patients.
- Current imaging practices for pediatric urolithiasis are not well-characterized.
Purpose of the Study:
- To characterize imaging utilization for children with suspected urolithiasis in emergency departments.
- To identify factors influencing the choice between computed tomography (CT) and ultrasound.
Main Methods:
- Retrospective cohort study using the 2006-2010 Nationwide Emergency Department Sample.
- Analysis of 18,096 pediatric visits for suspected urolithiasis.
- Logistic regression to determine factors associated with CT versus ultrasound use.
Main Results:
- Computed tomography (CT) was used in 87% of pediatric urolithiasis cases.
- CT utilization peaked in 2007 and subsequently declined.
- Factors associated with CT use included non-teaching hospitals and weekend visits.
Conclusions:
- Computed tomography (CT) remains highly prevalent for pediatric urolithiasis diagnosis.
- Ultrasound is infrequently used, even in high-volume pediatric centers.
- Increased awareness of CT risks and promotion of ultrasound are recommended.
Purpose:
Children are particularly vulnerable to the harmful effects of medical radiation, and children with urolithiasis comprise a group that may undergo repeated radiation intensive imaging tests. We sought to characterize imaging practices for children presenting to the emergency department with suspected urolithiasis and to determine factors associated with the choice of imaging study.
Materials And Methods:
Using the 2006 to 2010 Nationwide Emergency Department Sample, we conducted a retrospective cohort study of patients younger than 18 years presenting with suspected urolithiasis. We determined imaging practices for visits to emergency departments where billing codes for computerized tomography and ultrasound were reliably reported. Logistic regression was used to delineate patient and hospital level factors associated with the use of computerized tomography vs ultrasound.
Results:
We identified 18,096 pediatric visits for suspected urolithiasis in the 1,191 Nationwide Emergency Department Sample emergency departments with reliable imaging codes. A total of 11,215 patients underwent computerized tomography alone, ultrasound alone or both. Of the patients 9,773 (87%) underwent computerized tomography alone. Computerized tomography use peaked in 2007 and declined thereafter. On multivariate analysis several factors were associated with the use of computerized tomography alone, including smaller proportion of pediatric patients treated at the emergency department, older age, location in the Midwest or South, evaluation at a nonteaching hospital and visit on a weekend.
Conclusions:
Computerized tomography use is highly prevalent for children presenting with suspected urolithiasis. The lowest computerized tomography use is in emergency departments that care for more children. Ultrasound is used infrequently regardless of site. Awareness regarding risks of computerized tomography and consideration of alternatives including ultrasound are warranted in caring for these patients.
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