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Pediatric facilities buck trend of increasing CT use

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Though recent studies have indicated that the overall use of computed tomography (CT) is on the rise in emergency departments across the country, a recent Emory University study found no increase – and in some cases a decrease – in the use of CT in pediatric emergency departments.  

Though many studies have looked at CT utilization, this is the first of its kind with a large cohort of pediatric patients. Lead author of the study, Margaret J.A. Menoch, MD, and her collaborators retrospectively reviewed nearly a million electronic chart records from 2003 to 2010 at two of Children’s Healthcare of Atlanta’s emergency departments. CT scans were performed in 5.5 percent of the visits included in the study, of which 63 percent were head CTs. Twenty percent were of the abdomen/pelvis, three percent were of the cervical spine and 14 percent were classified as other.  

The greatest decrease in CT usage was reported in patients whose chief complaint was head injury and/or seizure. While there was no significant decrease in abdominal CTs, the rate of abdominal ultrasounds increased during the same time period, leading the study’s authors to hypothesize that physicians may be choosing non-radiation modalities instead of CT.  

“Although we cannot fully determine the reasons for overall decline in CT utilization within patients who presented with suspected head injuries or seizures, we do suspect that increased awareness of radiation risk, especially in children, may lead caregivers to hold off on ordering imaging, avoid radiation and use an observational approach instead,” says Menoch, a fellow in the department of pediatrics at Emory University School of Medicine.  

Though this study focused on pediatric facilities, it is estimated that more than 85 percent of CT imaging is performed at non-pediatric specific facilities.  

“We know that there will be cases when using CT is necessary, but because the majority of scanning in children takes place in primarily adult facilities, we hope to help the adult physician population be more aware of alternatives to using CTs when the situation allows for it,” says Menoch.

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