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Improvement in paediatric CT use and justification: a single-centre experience
Mariliis Tiidermann1,2, Triin Pihlakas1,2, Juhan Saaring2
1Department of Radiology, Institute of Clinical Medicine, University of Tartu, Ülikooli 18, Tartu 50090, Estonia.
Insights
Paediatric computed tomography (CT) use decreased significantly over a decade, while overall CT use increased. Appropriateness of paediatric CT scans improved, but further interventions are needed to optimize imaging referrals.
Area of Science:
- Radiology
- Medical Imaging
- Pediatric Imaging
Background:
- Paediatric computed tomography (CT) utilization has evolved over the past decade.
- Assessing the appropriateness of these examinations is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To analyze trends in paediatric CT utilization over ten years.
- To evaluate the appropriateness of paediatric CT examinations at a tertiary teaching hospital.
Main Methods:
- Prospective data collection of paediatric CTs in 2022, compared with 2017 and 2012 data.
- Evaluation of CT justification against medical imaging referral guidelines.
- Calculation of appropriateness rates for paediatric CT examinations.
Main Results:
- Paediatric CT use declined by 39.4%, while overall CT use rose by 27.6%.
- The proportion of paediatric CTs within overall CTs decreased from 2.5% to 1.1% (P < .0001).
- Overall CT appropriateness improved from 73.1% (2017) to 79.0% (2022) (P = .0049), with highest rates for angiography and chest, and lowest for head and neck.
Conclusions:
- Improvements in CT justification can be achieved through educational interventions, enhanced MRI accessibility, and pre-examination appropriateness reviews.
- Targeted interventions are necessary for effective implementation of referral guidelines, particularly for head and cervical spine trauma in paediatric patients.
Objectives:
To analyse changes in the use of paediatric (≤16 years) CT over the past decade and to evaluate the appropriateness of CT examinations at a tertiary teaching hospital.
Methods:
Data from 290 paediatric CTs were prospectively collected in 2022 and compared with data from 2017 (358 cases) and 2012 (538 cases). The justification of CTs was evaluated with regard to medical imaging referral guidelines and appropriateness rates were calculated.
Results:
Paediatric CTs decreased 39.4% over the 10 years, contrasting with a 27.6% increase in overall CTs. Paediatric CTs as the share of overall CTs dropped from 2.5% in 2012 to 1.1% in 2022 (P < .0001), with a concurrent rise in paediatric MRIs (P < .0001). Notable reductions in CT use occurred for head trauma (P = .0003), chronic headache (P < .0001), epilepsy (P = .037), hydrocephalus (P = .0078), chest tumour (P = .0005), and whole-body tumour (P = .0041). The overall appropriateness of CTs improved from 73.1% in 2017 to 79.0% in 2022 (P = .0049). In 15.4% of the cases, no radiological examination was deemed necessary, and in 8.7% of the cases, another modality was more appropriate. Appropriateness rates were the highest for the head and neck angiography (100%) and the chest (96%) and the lowest for the neck (66%) and the head (67%).
Conclusions:
Justification of CT scans can be improved by regular educational interventions, increasing MRI accessibility, and evaluating the appropriateness of the requested CT before the examination. Interventions for a more effective implementation of referral guidelines are needed.
Advances In Knowledge:
The focus for improvement should be CTs for head and cervical spine trauma, accounting for the majority of inappropriate requests in the paediatric population.
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