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Factors Influencing Temporal Trends in Pediatric Inpatient Imaging Utilization
Shae Anderson1, Janet Figueroa2, Courtney E McCracken2
1Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, Georgia.
Insights
Pediatric cardiac imaging use, including ultrasound and MRI, has increased. Noncardiac CT use declined, while cardiac CT use rose after 2014, influenced by patient factors and hospital characteristics.
Area of Science:
- Pediatric cardiology
- Medical imaging trends
- Health services research
Background:
- Limited data exists on pediatric cardiac imaging trends, contrasting with adult imaging growth.
- This study addresses the paucity of information on noninvasive cardiac imaging utilization in children.
Purpose of the Study:
- To analyze temporal trends in pediatric noninvasive cardiac imaging use.
- To compare these trends with noncardiac imaging utilization.
- To identify factors influencing pediatric imaging trends.
Main Methods:
- Utilized Pediatric Health Information Service database for inpatient data (2004-2017).
- Assessed trends in ultrasound, MRI, and CT for cardiac and noncardiac imaging.
- Employed linear mixed-effects models adjusted for case-mix, comorbidities, and hospital factors.
Main Results:
- Pediatric inpatient ultrasound and MRI utilization (cardiac and noncardiac) increased from 2004-2017.
- Noncardiac CT rates decreased, while cardiac CT use rose significantly after 2014.
- Case-mix index, cardiac surgical volume, and payer source impacted imaging trend drivers.
Conclusions:
- Cardiac and noncardiac ultrasound and MRI utilization is rising in pediatric inpatients.
- Cardiac CT use has increased post-2014, with specific influencing factors identified.
- This research provides a basis for studying imaging resource use and outcomes in pediatric populations.
Background:
Concern exists over exponential growth in cardiac imaging in adults, but there is paucity of such data for cardiac imaging trends in pediatric patients. The aims of this study were to determine temporal trends in the use of noninvasive cardiac imaging and compare these with trends in the use of noncardiac imaging and to identify factors influencing those trends using the Pediatric Health Information Service database.
Methods:
Pediatric inpatient encounter data from January 2004 to December 2017 at 35 pediatric hospitals were extracted from the Pediatric Health Information Service database. Temporal imaging utilization trends in cardiac and noncardiac ultrasound or echocardiography, magnetic resonance imaging (MRI), and computed tomography (CT) were assessed using linear mixed-effects models. Models were adjusted for case-mix index, complex chronic conditions, patient age, length of stay, payer source, and cardiac surgical volume.
Results:
A total of 5,869,335 encounters over 14 years were analyzed (median encounters per center per year, 11,411; median patient age, 4 years; median length of stay, 3 days). From 2004 to 2017, the rates of pediatric inpatient cardiac and noncardiac ultrasound and MRI increased, whereas the rate of noncardiac CT decreased. Cardiac CT use increased beginning in 2014 (+0.264 cardiac CT encounters per 1,000 encounters per year), surpassing the rate of rise of cardiac MRI. Case-mix index, cardiac surgical volume, and payer source affected the largest number of imaging trends.
Conclusions:
Among pediatric inpatients, utilization of cardiac and noncardiac ultrasound and MRI has steadily increased. Noncardiac CT use declined and cardiac CT use increased after 2014. Factors influencing imaging trends include case-mix index, cardiac surgical volume, and payer source. This study lays a foundation for investigations of imaging-related resource utilization and outcomes among pediatric inpatients.
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