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Frequency, cost, and variation in inpatient diagnostic imaging use in children's hospitals
Megan E Collins1,2, John R Stephens3, Matt Hall1,4
1Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.
Insights
Chest X-rays (CXRs) and cardiovascular ultrasounds are the most common and expensive imaging tests for hospitalized children. These studies, particularly in intensive care units (ICUs) and for complex chronic conditions (CCCs), drive significant healthcare costs.
Area of Science:
- Pediatric healthcare research
- Medical imaging analysis
- Health economics
Background:
- Diagnostic imaging is essential for pediatric patient care.
- Prevalence and cost of imaging studies in hospitalized children remain largely unknown.
- Understanding imaging utilization is crucial for cost containment and quality improvement.
Purpose of the Study:
- To identify the most frequent, costly, and repeated diagnostic imaging studies in hospitalized children.
- To analyze imaging patterns in intensive care unit (ICU) patients and those with complex chronic conditions (CCCs).
- To assess interhospital variation in imaging practices.
Main Methods:
- Retrospective cohort study of over 1.5 million pediatric hospital encounters from 2021-2022 across 45 children's hospitals.
- Utilized billing codes to identify and categorize diagnostic imaging studies by modality and body system.
- Measured imaging frequency, costs, repetition rates, and hospital variation, stratified by patient populations (ICU, CCCs).
Main Results:
- 59.1% of encounters included imaging, totaling $2.03 billion in costs.
- Chest X-rays (CXRs), abdominal X-rays, and cardiovascular (CV) ultrasounds were most frequent and repeated.
- CV ultrasounds, CXRs, and neuro/head MRIs incurred the highest cumulative costs.
- ICU and CCC encounters represented a disproportionate share of imaging costs (44.6% and 74.2%, respectively).
Conclusions:
- CXRs and CV ultrasounds are leading drivers of imaging frequency and cost in hospitalized children.
- Patients in ICUs and those with CCCs account for a significant majority of imaging expenditures.
- Findings provide a foundation for identifying imaging overuse and establishing care benchmarks.
Background:
Diagnostic imaging studies are frequently utilized when caring for pediatric patients. The most prevalent and costly imaging studies among hospitalized children are unknown.
Objective:
Identify imaging studies with highest frequency, cost, rates of repetition, and hospital variation among hospitalized children, including patients with intensive care (ICU) stays and complex chronic conditions (CCCs).
Methods:
We performed a retrospective cohort study of patients hospitalized from January 1, 2021 to December 31, 2022 across 45 children's hospitals in the Pediatric Health Information System. We identified diagnostic imaging studies for inpatient and observation encounters using billing codes grouped by body system and modality. We measured imaging frequency, costs, and variation across hospitals, overall and for ICU stays and children with CCCs.
Results:
We identified 1,523,343 encounters; 59.1% had imaging, with $2.03 billion in imaging costs. The most frequently obtained and repeated imaging included chest X-ray (CXR), abdominal X-ray, and cardiovascular (CV) ultrasound/echocardiography. The imaging studies with highest cumulative cost were cardiovascular ultrasound, CXR, and neuro/head MRI. ICU encounters were 15.1% of total encounters, but accounted for 44.6% of imaging costs; CCC encounters were 39.6% of the total but accounted for 74.2% of costs. Interhospital variation was low among the most frequent and costly imaging modalities.
Conclusions:
Among a cohort of hospitalized children, CXR and CV ultrasounds were among the most prevalent, costly, and frequently repeated imaging studies. Encounters with ICU stays and for patients with CCCs incurred disproportionate imaging costs. Our results serve as a starting point for identifying imaging overuse and developing achievable benchmarks of care.
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