Low-Value Computed Tomography for Children in the Emergency Department: A Repeated Cross-Sectional Study

Area of Science:

• Pediatric Emergency Medicine
• Health Services Research
• Radiology

Background:

• Computed tomography (CT) scans are frequently used in pediatric emergency departments (EDs).
• Guidelines exist to reduce low-value CT use for certain pediatric diagnoses.
• Variations in CT utilization by hospital type and provider specialty are not well understood.

Purpose of the Study:

• To compare the utilization of low-value computed tomography (CT) scans in pediatric emergency department (ED) visits.
• To analyze variations in CT use based on hospital type and physician specialty.

Main Methods:

• A repeated cross-sectional study analyzed linked databases from Ontario, Canada (2010-2019).
• Pediatric ED discharges for five diagnoses with recommendations against routine CT use were reviewed.
• Multivariable logistic regression adjusted for patient, ED, and physician characteristics to evaluate CT use by hospital type and provider specialty.

Main Results:

• Over 599,000 pediatric ED discharges were analyzed.
• Children treated at adult academic and community hospitals (with or without pediatric consultation) had higher odds of receiving CT scans compared to pediatric academic hospitals.
• Patients seen by non-pediatric providers were more likely to receive CT scans for all diagnoses compared to pediatric emergency medicine physicians.

Conclusions:

• Low-value CT utilization is significantly higher in children treated at non-pediatric EDs and by non-pediatric providers.
• Improvement initiatives should focus on specific hospital types and physician specialties to reduce unnecessary CT scans.