Skip to main content

Increasing utilization of computed tomography in the pediatric emergency department, 2000–2006

Emergency Radiology volume 14, pages 227–232 (2007)Cite this article

Abstract

The objective of this study is to characterize changes in computed tomography (CT) utilization in the pediatric emergency department (ED) over a 6-year period. CT scans ordered on pediatric (ages 0 to 17 years) ED patients from July 2000 to July 2006 were analyzed in five groups: head, cervical spine, chest, abdomen, and miscellaneous. Pediatric ED patient volume and triage acuity scores were determined. There were 6,073 CT scans performed on 4,138 pediatric patients in the ED during the study period. During this same period, 78,932 pediatric patients were evaluated in the ED. From 2000 to 2006, pediatric ED patient volume increased by 2%, while triage acuity remained stable. During this same period, head CT increased by 23%, cervical spine CT by 366%, chest CT by 435%, abdominal CT by 49%, and miscellaneous CT by 96%. Increases in CT utilization were most pronounced in adolescents ages 13 to 17 years. Increases in CT utilization in this age group met or exceeded increases seen in the adult population. In children less than 13 years of age, increases were substantially smaller. Pediatric ED CT utilization particularly in the adolescent population has increased at a rate far exceeding the growth in ED patient volume, mimicking the adult trend. This increase has occurred despite considerable discussion in the medical literature about the radiation risks of CT in the pediatric population and may reflect increased availability of CT, improvements in CT diagnostic capabilities, and increased desire on the part of physicians and patients for diagnostic certainty. Whether this increased utilization results in improved patient outcomes is uncertain and deserves further study.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Broder J, Warshauer DM (2006) Increasing utilization of computed tomography in the adult emergency department, 2000–2005. Emerg Radiol 13(1):25–30

    PubMed  Article  Google Scholar 

  2. Brenner D et al (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176(2):289–296

    PubMed  CAS  Google Scholar 

  3. Linton OW, Mettler FA Jr (2003) National conference on dose reduction in CT, with an emphasis on pediatric patients. AJR Am J Roentgenol 181(2):321–329

    PubMed  Google Scholar 

  4. Tanabe P et al (2004) Reliability and validity of scores on the emergency severity index version 3. Acad Emerg Med 11(1):59–65

    PubMed  Article  Google Scholar 

  5. Mettler FA Jr et al (2000) CT scanning: patterns of use and dose. J Radiol Prot 20(4):353–359

    PubMed  Article  Google Scholar 

  6. Donnelly LF et al (2001) Minimizing radiation dose for pediatric body applications of single-detector helical CT: strategies at a large children’s hospital. AJR Am J Roentgenol 176(2):303–306

    PubMed  CAS  Google Scholar 

  7. Donnelly LF (2005) Reducing radiation dose associated with pediatric CT by decreasing unnecessary examinations. AJR Am J Roentgenol 184(2):655–657

    PubMed  Google Scholar 

  8. McCollough CH, Bruesewitz MR, Kofler JM Jr (2006) CT dose reduction and dose management tools: overview of available options. Radiographics 26(2):503–512

    PubMed  Article  Google Scholar 

  9. Hadley JL, Agola J, Wong P (2006) Potential impact of the American College of Radiology appropriateness criteria on CT for trauma. AJR Am J Roentgenol 186(4):937–942

    PubMed  Article  Google Scholar 

  10. Kharbanda AB et al (2005) A clinical decision rule to identify children at low risk for appendicitis. Pediatrics 116(3):709–716

    PubMed  Article  Google Scholar 

  11. Oman JA et al (2006) Performance of a decision rule to predict need for computed tomography among children with blunt head trauma. Pediatrics 117(2):e238–e246

    PubMed  Article  Google Scholar 

  12. van Belle A et al (2006) Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA 295(2):172–179

    PubMed  Article  Google Scholar 

  13. Centers for Disease Control and Prevention (2007) WISQARS (Web-based Injury Statistics Query and Reporting System). Available from: http://www.cdc.gov/ncipc/wisqars/ (cited; an interactive database system that provides customized reports of injury-related data)

  14. Thomas KE et al (2006) Assessment of radiation dose awareness among pediatricians. Pediatr Radiol 36(8):823–832

    PubMed  Article  Google Scholar 

  15. Lee CI et al (2004) Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology 231(2):393–398

    PubMed  Article  Google Scholar 

  16. Shiralkar S et al (2003) Doctors’ knowledge of radiation exposure: questionnaire study. BMJ 327(7411):371–372

    PubMed  Article  CAS  Google Scholar 

  17. Schutzman SA et al (2001) Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines. Pediatrics 107(5):983–993

    PubMed  Article  CAS  Google Scholar 

  18. Viccellio P et al (2001) A prospective multicenter study of cervical spine injury in children. Pediatrics 108(2):E20

    PubMed  Article  CAS  Google Scholar 

  19. Mazonakis M et al (2007) Thyroid dose from common head and neck CT examinations in children: is there an excess risk for thyroid cancer induction? Eur Radiol 17(5):1352–1357

    PubMed  Article  Google Scholar 

  20. Salim A et al (2006) Whole body imaging in blunt multisystem trauma patients without obvious signs of injury: results of a prospective study. Arch Surg 141(5):468–473, discussion 473–475

    PubMed  Article  Google Scholar 

  21. Renton J, Kincaid S, Ehrlich PF (2003) Should helical CT scanning of the thoracic cavity replace the conventional chest X-ray as a primary assessment tool in pediatric trauma? An efficacy and cost analysis. J Pediatr Surg 38(5):793–797

    PubMed  Article  CAS  Google Scholar 

  22. Tiao GM et al (2000) Cardiac and great vessel injuries in children after blunt trauma: an institutional review. J Pediatr Surg 35(11):1656–1660

    PubMed  Article  CAS  Google Scholar 

  23. Fenton SJ et al (2004) CT scan and the pediatric trauma patient—are we overdoing it? J Pediatr Surg 39(12):1877–1881

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Sergio Rabinovich, Tech Support Analyst, Department of Emergency Medicine, University of North Carolina at Chapel Hill.

Author information

Authors and Affiliations

  1. Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Box 3096, Durham, NC, 27710, USA

    Joshua Broder

  2. Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, USA

    Lynn Ansley Fordham & David M. Warshauer

Authors
  1. Joshua Broder
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lynn Ansley Fordham
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David M. Warshauer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joshua Broder.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Broder, J., Fordham, L.A. & Warshauer, D.M. Increasing utilization of computed tomography in the pediatric emergency department, 2000–2006. Emerg Radiol 14, 227–232 (2007). https://doi.org/10.1007/s10140-007-0618-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10140-007-0618-9

Keywords

  • Computed tomography
  • Utilization
  • Emergency treatment
  • Process assessment
  • Pediatric