Rising Use of CT in Child Visits to the Emergency Department in the United States, 1995–2008
Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229, USA. Radiology
(Impact Factor: 6.87).
04/2011; 259(3):793-801. DOI: 10.1148/radiol.11101939
To describe nationwide trends and factors associated with the use of computed tomography (CT) in children visiting emergency departments (EDs) in the United States between 1995 and 2008.
This study was exempt from institutional review board oversight. Data from the 1995-2008 National Hospital Ambulatory Medical Care Survey were used to evaluate the number and percentage of visits associated with CT for patients younger than 18 years. A mean of 7375 visits were sampled each year. Data were subcategorized according to multiple patient and hospital characteristics. The Rao-Scott χ(2) test was performed to determine whether CT use was similar across subpopulations.
From 1995 to 2008, the number of pediatric ED visits that included CT examination increased from 0.33 to 1.65 million, a fivefold increase, with a compound annual growth rate of 13.2%. The percentage of visits associated with CT increased from 1.2% to 5.9%, a 4.8-fold increase, with a compound annual growth rate of 12.8%. The number of visits associated with CT at pediatric-focused and non-pediatric-focused EDs increased from 14,895 and 316,133, respectively, in 1995 to 212,716 and 1,438,413, respectively, in 2008. By the end of the study period, top chief complaints among those undergoing CT included head injury, abdominal pain, and headache.
Use of CT in children who visit the ED has increased substantially and occurs primarily at non-pediatric-focused facilities. This underscores the need for special attention to this vulnerable population to ensure that imaging is appropriately ordered, performed, and interpreted.
Available from: sciencedirect.com
- "Since it is widely available, its use for evaluation of pediatric abdominal pain has markedly increased in the past decade   . "
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ABSTRACT: There are safety concerns about the use of radiation-based imaging (computed tomography [CT]) to diagnose appendicitis in children. Factors associated with CT use remain to be determined.
For patients ≤18years old undergoing appendectomy, we evaluated diagnostic imaging performed, patient characteristics, hospital type, and imaging/pathology concordance (2008-2012) using data from Washington State's Surgical Care and Outcomes Assessment Program.
Among 2538 children, 99.7% underwent pre-operative imaging. 52.7% had a CT scan as their first study. After adjustment, age >10years (OR 2.9 (95% CI 2.2-4.0), Hispanic ethnicity (OR 1.7, 95% CI 1.5-1.9), and being obese (OR 1.7, 95% CI 1.4-2.1) were associated with CT use first. Evaluation at a non-children's hospital was associated with higher odds of CT use (OR 7.9, 95% CI 7.5-8.4). Ultrasound concordance with pathology was higher for males (72.3 vs. 66.4%, p=.03), in perforated appendicitis (75.9 vs. 67.5%, p=.009), and at children's hospitals compared to general adult hospitals (77.3 vs. 62.2%, p<.001). CT use has decreased yearly statewide.
Over 50% of children with appendicitis had radiation-based imaging. Understanding factors associated with CT use should allow for more specific QI interventions to reduce radiation exposure. Site of care remains a significant factor in radiation exposure for children.
Copyright © 2015 Elsevier Inc. All rights reserved.
Journal of Pediatric Surgery 04/2015; 50(4):642-646. DOI:10.1016/j.jpedsurg.2014.09.080 · 1.39 Impact Factor
Available from: Hye Sun Lee
- "Consequently, there has been a dramatic increase in radiation exposure: two-fold in per capita radiation dosage (from 3.6 mSv to 6.2 mSv) and six-fold in annual dosage from medical radiation (from 0.54 mSv to 3 mSv) in the United States (US) population between the early 1980s and 2006 [1,2]. Similar to rates observed in the general population, radiation exposure in injury patients who visited an emergency department (ED) has continuously increased; this rise is mainly due to the fact that CT has become one of the most important tools in the evaluation and planning for appropriate injury treatment [3,4,5]. "
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ABSTRACT: In contrast to patients with underlying cancer or chronic disease, injury patients are relatively young, and can be expected to live their natural lifespan if injuries are appropriately treated. Multiple and repeated diagnostic scans might be performed in these patients during admission. Nevertheless, radiation exposure in injury patients has been overlooked and underestimated because of the emergent nature of such situations. Therefore, we tried to assess the cumulative effective dose (cED) of injury patients in the emergency department. We included patients who visited the emergency department (ED) of a single tertiary hospital due to injury between February 2010 and February 2011. The cED for each patient was calculated and compared across age, sex and injury mechanism. A total of 11,676 visits (mean age: 28.0 years, M:F = 6,677:4,999) were identified. Although CT consisted of only 7.8% of total radiologic examinations (n=78,025), it accounted for 87.1% of the total cED. The mean cED per visit was 2.6 mSv. A significant difference in the cED among injury mechanisms was seen (p<0.001) and patients with traffic accidents and fall down injuries showed relatively high cED values. Hence, to reduce the cED of injury patients, an age-, sex- and injury mechanism-specific dose reduction strategy should be considered.
PLoS ONE 12/2013; 8(12):e84870. DOI:10.1371/journal.pone.0084870 · 3.23 Impact Factor
Available from: ocean.kisti.re.kr
- ". 특히 영·유아의 응급실에서의 CT 사용이 급격히 증가 하였다  . Brenner 등  "
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ABSTRACT: This study presents comparison results between axial and spiral scanning in the head and chest region with 64 MDCT to evaluate organ doses in infants and toddlers, who are more radiosensitive to radiation than adults and rise in the number of CT examinations, during CT scanning. Organ doses were significantly lower in spiral scanning than axial scanning regardless of scanned regions. The average organ dose for the chest scan using pitch of 1.355 was found to be significantly higher(average -12.03%) than for the other two pitch settings(0.525 and 0.988) in the spiral scanning mode compared with the axial one. Organ doses in the spiral scanning mode were lower by average 20.54% than the axial scanning mode. The results of the study that evaluated organ doses with an anthropomorphic phantom will help to demonstrate the result values of Monte Carlo simulations and make a contribution to more accurate evaluations of organ doses in toddlers undergoing a CT examination.
04/2013; 7(2). DOI:10.7742/jksr.2013.7.2.137
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