CT Use in ED Has Increased 6-Fold, Used Frequently in Children

Emma Hitt, PhD

January 03, 2011

January 3, 2011 — From 1995 to 2007, the number of emergency department (ED) visits that included a computed tomography (CT) examination increased from 2.7 million to 16.2 million, constituting a 5.9-fold increase — or a 16% increase per year — according to a new analysis of survey data.

David B. Larson, MD, from the Cincinnati Children's Hospital Medical Center in Ohio, and colleagues reported their findings in the January 2011 issue of Radiology.

"We found that the use of CT in the ED in the United States has increased at a consistent exponential rate and at a rate higher than that reported in other settings," Dr. Larson and colleagues note. They suggest that the increased use of CT is related to "a higher frequency of scanning for the same indications reported in the past and an increasing number of reasons to use the technology."

Dr. Larson and colleagues analyzed data from the 1995 to 2007 National Hospital Ambulatory Medical Care Survey to evaluate CT in an average of 30,044 ED visits per year.

From 1995 to 2007, the number of ED visits that involved CT increased from 2.8% to 13.9%, representing a 4.9-fold increase and a growth rate of 14.2% per year.

CT was used more frequently among older patients, white patients, those who were admitted to the hospital, and those in facilities in urban areas.

The most common reasons for CT were abdominal pain, headache, and chest pain. The greatest increase in CT use was among patients who underwent CT for flank, abdominal, or chest pain (32%, 26%, and 21%, respectively).

According to the researchers, increasing use of CT scanning accounted for most (12.7%) of the 16% annual growth. The remainder of the increase (3.3%) was attributable to an increase in the overall number of visits to the ED.

A second study by Adam L. Dorfman, MD, from the University of Michigan Health Systems in Ann Arbor, and colleagues assessed x-ray and CT use in 355,088 children. Overall, 42.5% underwent imaging, with plain radiography accounting for 84.7% of imaging procedures performed, and CT (associated with higher doses of radiation) accounting for 11.9% of all procedures.

The study was published online January 3 in the Archives of Pediatrics & Adolescent Medicine.

Overall, they found that 7.9% of children received at least 1 CT scan and 3.5% received 2 or more, with CT scans of the head being the most frequent.

"Studies associated with high doses of radiation are not infrequent and are performed repeatedly in a smaller group of children," the researchers conclude. "These results highlight the importance of generating databased guidelines to aid clinicians in determining the appropriateness of performing imaging procedures in children," they conclude.

The studies were not commercially funded. The authors of the study published in Radiology have disclosed no relevant financial relationships. The authors of the study published in the Archives of Pediatrics & Adolescent Medicine report financial relationships with the following companies and institutions: International Atomic Energy Agency, GE Healthcare, Spectrum Dynamics, Covidien, INVIA, Philips Medical Systems, Toshiba America Medical Systems, Springer Publishing, United Healthcare, National Institutes of Health, American Heart Association, Louis V Gerstner Jr Scholars Program, Lewis Katz Cardiovascular Research Prize, and the Agency for Healthcare Research and Quality.

Radiology. 2011;258:164-173. Abstract

Arch Pediatr Adolesc Med. Published online January 3, 2011.

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