CT potentially overused to access pediatric injuries from falls
A study from the Mayo Clinic has documented that the number of CT exams ordered to assess injuries from falls by children admitted to hospital emergency departments increased by twofold between 2001 to 2010. The analysis surveying approximately 500 emergency departments suggests that CT may be overutilized among pediatric fall patients, and that radiologists should be alert to this.
A common estimate is that children in the United States 18 years of age and younger have at least four million CT exams performed each year. Falls represent the highest percentage of reasons that children are brought to a hospital emergency department. Concerned about the possibility that unnecessary imaging may be ordered for children to determine if they have been injured from a fall, lead author Varun Shahi, a student at the college of medicine and radiologists at the Mayo Clinic in Rochester, MN, decided to evaluate CT utilization trends using the National Hospital Ambulatory Medical Care Survey (NHAMCS).
Information was collected on gender, age, ethnicity, arrival method (ambulance or other means), whether the patient had a life-threatening injury, whether the patient was admitted to the hospital, and insurance status. The researchers were particularly interested in determining the correlation between the diagnosis of life-threatening injuries and the ratio of emergency department visits in which CT exams were ordered.
Out of a total of 32,432,686 individual visits associated with a fall, the number of pediatric fall cases ranged from a minimum of 2,876,799 patients in 2002 to a maximum of 3,665,240 patients in 2010. The median patient age was seven years. Approximately 42% were children aged 5 and under, 14.4% of whom were infants 12 months of age and under. Only 6.8% of the total arrived by ambulance and only 1.7% were subsequently hospitalized.
The proportion of pediatric patients who had CT exams increased from 5.3% in 2001, reaching a peak of 16.6% in 2009 and decreasing to 11.3% in 2010. The greatest reduction was in infants, which, after increasing to 27.6% in 2008 started a decline to 12.2% in 2010. This was not the case for children aged 6 to 12; 21% had CT exams in 2001, but steadily escalated to 48.1% in 2010. Throughout this time, the prevalence of life-threatening conditions remained a stable percentage. The authors suggest that the higher likelihood of the 0-1 year age group having a CT exam could be due to the fact that physical exam findings for this age group may be less reliable than with older children.
In view of the fact that an awareness campaign to “Image Gently” and to minimize radiation exposure to pediatric patients whenever possible was well underway in 2010, this study merits a follow up for subsequent years. Radiologists who work with emergency physicians need to be diligent about the ordering of CT exams for this pediatric subgroup and to proactively recommend alternatives when clinically feasible.
Reference
- Shahi, V, Brinjikji W, Cloft HJ et al. Trends in CT Utilization for Pediatric Fall Patients in U.S. Emergency Departments. Acad Radiol. Published online May 6, 2015.