Considerable Increase in Pediatric CT Imaging Seen in the Emergency Departments

Computed tomography (CT) scans of children in hospital emergency departments increased substantially from 1995 to 2008. Researchers reported that these findings emphasize the need for collaboration among medical professionals to ensure that pediatric CT is appropriately ordered, performed, and interpreted.

The study's findings were published in the online edition of the journal Radiology. "We need to think creatively about how to partner with each other, with ordering clinicians and with CT manufacturers to ensure that all children are scanned only when it is appropriate and with appropriate techniques,” said the study's lead author, David B. Larson, MD, MBA, director of quality improvement in the department of radiology at Cincinnati Children's Hospital Medical Center (OH, USA).

Developments in CT technology such as helical scanning have made it a major tool for rapid diagnostic evaluation of children in the emergency department. Decreased scan times are particularly helpful in eliminating the need for sedation in many pediatric cases.
However, the relatively higher radiation doses associated with CT, compared to most other imaging exams, have raised concerns over an increase in risks tied to ionizing radiation. A child's organs are more sensitive to the effects of radiation than those of an adult, and they have a longer remaining life expectancy in which cancer may potentially form. Moreover, the current prevalence of CT makes it more likely that children will receive a higher cumulative lifetime dose of medically related radiation than those who are currently adults.

To evaluate CT utilization trends in children, Dr. Larson and colleagues analyzed US National Hospital Ambulatory Medical Care Survey data from 1995 to 2008.

The number of pediatric emergency department visits that included a CT examination increased five-fold over the study period, from roughly 330,000 to 1.65 million, with a compound annual growth rate of 14.3%. The leading complaints among those receiving CT included head injury, abdominal pain, and headache. The rate of imaging for abdominal pain increased the most, because of advancements in the technology.

"We found that abdominal CT imaging went from almost never being used in 1995 to being used in 15%-21% of visits in the last four years of the study,” Dr. Larson said. "In 1995, abdominal CT took much longer, the resolution was not as good, and the research hadn't been done to support it. By 2008, helical scanning had helped make CT very useful for abdominal imaging. It's widely available, it's fast, and there are a lot of great reasons to do it, but it does carry a higher radiation dose.”

Dr. Larson pointed out that abdominal CT's effective dose of radiation is up to seven times that of a head CT, suggesting that the radiation dose to children in emergency departments increased at an even higher rate from 1995 to 2008 than the rate of increase in the percentage of visits in which CT was performed.

Nonpediatric focused emergency departments made up 89.4% of emergency department visits associated with CT in children and increased from 316,133 examinations to 1,438,413 over the study period. Dr. Larson noted that most of the radiologists who oversaw and interpreted these studies likely were not subspecialty-trained in pediatric radiology. "The performance of CT in children requires special oversight, especially in regards to the selection of size-based CT scan parameters and sedation techniques. It is important to consistently tailor CT technique to the body size of the pediatric patient,” he said.

Related Links:
Cincinnati Children's Hospital Medical Center