Imaging Utilization Among Pediatric Beneficiaries at Children's Hospital Versus Non-Children's Hospital Outpatient...

The aim of this study was to compare imaging use on pediatric outpatients at children's hospitals (CHs) versus non-children's hospitals (NCHs) to identify differences across modalities that differ in ionizing radiation exposure.

CMS Medicaid Research Identifiable Files were used to identify all year 2019 pediatric (ages 0-17 years) outpatient claims from hospital outpatient facilities (HOFs) and emergency departments (EDs). CMS data from 2018 were used to calculate the pediatric comorbidity index (PCI) for risk adjustment. Primary outcomes were CT, MR, ultrasound, or radiography (XR) use at each visit, comparing frequencies between CHs and NCHs. Additional covariates included age group (0, 1-2, 3-5, 6-11, and 12-17 years), PCI (0, 1 or 2, 3-6, 7), and place of service (HOF vs ED).

A total of 5,474,082 claims meeting the selection criteria were identified. More than half of visits (53%) were to CHs, and 15% were to EDs. CH encounters were more likely (vs NCH encounters) to be among patients aged 0 to 5 years versus >5 years (41.2% vs 38.7%, P < .01), those with PCI > 2 (32.3% vs 22.9%, P < .01), and those seen at HOFs (87.8% vs 81.9%, P < .01). The most commonly used modalities were XR (9.5%) and ultrasound (2.1%). Use of XR (11.8% vs 7.5%, P < .01) and CT (1.0% vs 0.5%, P < .01) was more frequent at NCHS. Use of ultrasound (2.5% vs 1.7%, P < .01) and MR (0.9% vs 0.5%, P < .01) was more frequent at CHs.

This study reveals that imaging modalities that expose children to ionizing radiation are used more frequently at NCHs than at CHs. The clinical implications of these variations warrant further investigation.