Pediatric Imaging Use in Emergency Department on the Rise

In emergency rooms nationwide, the use of diagnostic imaging is on the rise with pediatric patients, a new study shows.

Between 2009 and 2018, a study published Aug. 3 in JAMA Pediatrics reveals, emergency providers ordered more MRI scans and ultrasounds for pediatric patients. But, the amount of CT scans requested fell.

By examining records from more than 26 million emergency department visits from Jan. 1, 2009, to Dec. 31, 2018, a team from the University of Pittsburgh Medical Center, led by Jennifer Marin, M.D., MSc, associate professor of pediatrics and emergency medicine, calculated the change in ordering rates for ultrasounds, MRIs, and CTs. The data came from the Pediatric Health Information System administrative database.

They found only CT use decreased during the study time frame. And, it was variable based upon location and other diagnostic strategies used.

“The magnitude of the decrease in CT use varied by site and was associated, in part, with the use of alternative advanced imaging modalities for certain diagnoses, most notably ultrasonography for abdominal conditions,” the team wrote.

In an accompanying editorial, pediatric and emergency medicine providers Alan Schroeder, M.D., and Daniel Imler, M.D., from Stanford University School of Medicine, noted that while the reduced radiation exposure from CT in children falls in line with the Image Gently campaign and is encouraging, the overall exposure of pediatric patients to advanced imaging is still not optimal.

Pediatric Emergency Department Imaging Use Changes

Overall, in this study, the drop in CT use can be attributed to decreases in eight areas: concussion (23-percent drop); appendectomy (14.9-percent drop); ventricular shunt procedures (13.3-percent drop); migraine and other headaches (12.4-percent drop); nervous system disorders (10.1-percent drop); abdominal pain (6.1-percent drop); ear, nose, mouth, throat, cranial, facial diagnoses (5.9-percent drop); and seizure (5.3-perent drop).

For abdominal pain, the investigators found that the implementation rate of abdominal ultrasound surpassed the accompanying reduction in abdominal CT scans, pointing to a potential overuse of ultrasound.

While the length-of-stay in the emergency department did not change and hospitalizations and 3-day re-visit rates decreased during the study time frame, the team did find significant variations in imaging use in emergency departments nationwide. Specifically, use varied for ultrasound for appendectomy (median 57.5 percent), MRI (median 15.8 percent), and CT for ventricular shunt procedures (median 69.5 percent).

According to Schroeder and Imler, the higher use of imaging for patients who were ultimately hospitalized indicated that more imaging use does not necessarily result in reduced hospitalization.