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National Imaging Trends in Pediatric Traumatic Brain Injury and Hydrocephalus
Allie Harbert1, Kathleen Bradford2, Victor Ritter3
1School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
Insights
Pediatric CT use decreased while MRI use increased nationwide for hydrocephalus and TBI. However, significant regional variations in CT reduction persist across the US.
Area of Science:
- Pediatric radiology
- Neuroradiology
- Health services research
Background:
- Computed tomography (CT) use in children, particularly for conditions like hydrocephalus and traumatic brain injury (TBI), raises concerns about radiation exposure.
- Magnetic resonance imaging (MRI) offers a radiation-free alternative, but its adoption varies.
- Understanding national trends in imaging modality utilization is crucial for optimizing pediatric care.
Purpose of the Study:
- To analyze national trends in CT and rapid-sequence MRI usage for pediatric hydrocephalus and TBI.
- To identify factors influencing imaging practices and barriers to reducing CT utilization.
Main Methods:
- Retrospective review of deidentified pediatric discharge data (2000-2016) from the Kids' Inpatient Database.
- Extraction of CT and MRI utilization data using ICD codes.
- Analysis of regional variations and age cohorts using chi-squared tests and logistic regression.
Main Results:
- Overall CT utilization decreased, while MRI utilization increased for both hydrocephalus and TBI diagnoses.
- Significant regional disparities were observed, with higher CT rates in the Northeast and lower rates in the South.
- No significant regional variation was found for MRI use in TBI patients.
Conclusions:
- Nationwide trends show a reduction in pediatric CT use and an increase in MRI use for hydrocephalus and TBI.
- Despite overall progress, inconsistent CT reduction across different US regions highlights ongoing challenges.
Objective:
Reduction in use of computed tomography (CT) in favor of rapid-sequence magnetic resonance imaging (MRI) to decrease pediatric radiation exposure has varied across institutions in the United States. The aims of this study were to understand national trends in CT and rapid-sequence MRI usage and identify variables affecting imaging practices and obstacles to CT reduction.
Methods:
This was a retrospective review of deidentified discharge data for children with hydrocephalus and traumatic brain injury (TBI) in the Healthcare Cost and Utilization Project Kids' Inpatient Database in 2000, 2003, 2006, 2009, 2012, and 2016. Utilization of MRI without contrast and CT was extracted using International Classification of Diseases, Ninth Revision, and International Classification of Diseases, Tenth Revision, codes. Hospital region and age cohorts were extracted and used to categorize data. χ2 tests and logistic regression were used for analysis.
Results:
Hospitalizations utilizing CT decreased (P < 0.05) and hospitalizations utilizing MRI increased (P < 0.05) overall in both diagnosis groups throughout the years analyzed. However, there was significant regional variation in imaging. The Northeast had higher CT rates (P < 0.05) and the South had lower CT rates in patients with hydrocephalus and TBI (P < 0.05). No regional variation was found for rates of MRI use in patients with TBI.
Conclusions:
Nationwide, the average number of discharges after hospitalizations utilizing CT in patients with hydrocephalus and TBI has decreased, while discharges after hospitalizations utilizing MRI as an alternative imaging modality have increased. Despite successful overall CT reduction, significant regional variation exists within this trend showing inconsistent reduction of CT use.
