Pediatric EDs Using CT Less Often; Ultrasounds, MRIs on the Rise

By Anne Harding

August 07, 2020

NEW YORK (Reuters Health) - Use of advanced imaging in pediatric emergency departments (EDs) increased from 2009-2018 in the U.S., despite a drop in computed tomography (CT), according to new findings.

"In the last decade, a higher proportion of pediatric ED visits included advanced imaging. This increase was being driven by non-radiating modalities, specifically ultrasound, and also MRI," Dr. Jennifer R. Marin of Children's Hospital of Pittsburgh told Reuters Health by email.

Concerns have been raised about the increased risk of cancer associated with radiation exposure from CT, especially in children, which may have led to a decline in its use, Dr. Marin and her team note in JAMA Pediatrics. They hypothesized that reduced CT use would be accompanied by increased use of ultrasonography and magnetic resonance imaging (MRI).

To investigate, they reviewed Pediatric Health Information System data on more than 26 million visits to 32 pediatric EDs in the U.S. Advanced imaging studies were used in nearly 2 million encounters (7.4%).

The proportion of visits including at least one advanced imaging test increased from 6.4% in 2009 to 8.7% in 2018. The percentage of visits including a CT scan declined from 3.9% to 2.9% over the study period. Visits including ultrasonography increased from 2.5% to 5.8%, and MRI use increased from 0.3% to 0.6%.

CT rates declined the most for concussion (by 23%), appendectomy (by 14.9%), ventricular shunt procedures (by 13.3%) and headaches (by 12.4%).

The authors also found large variations across EDs in the use of ultrasound for appendectomy and MRI and CT for ventricular shunt procedures.

There was no significant change in ED length of stay during the study period, while hospitalizations and three-day ED visit rates declined.

While it was not possible to evaluate the appropriateness of each imaging study, Dr. Marin noted, the findings suggest that there may be some overuse of MRI and ultrasound.

"We know from other studies that some imaging performed in the emergency department is not necessarily indicated (i.e. 'low-value')," she added. "More imaging isn't necessarily better and our findings should prompt clinicians and departments to evaluate their local practice patterns and consider ways to optimize their use of these advanced imaging modalities."

CT use declined from 2009-2014, but subsequently plateaued, the researcher noted. "It's likely that we have more work to do to further decrease CT use in pediatric emergency department patients," she said. "Data comparing CT use for children in the U.S. compared with Ontario (Canada) really highlight how much more CT is being used in the U.S. and the potential improvements we can make."

Dr. Alan Schroeder of Stanford University School of Medicine, in California, co-authored an editorial accompanying the study. "There really has been a concerted effort, both in my own anecdotal experience but as evidenced by this and other studies, to decrease exposure to ionizing radiation in children, and I think that's great," he told Reuters Health by phone. "It shows that people are willing to follow new recommendations that advocate for children."

But the increase in ultrasound and MRI use may have implications for the costs of care and for quality of care and outcomes, he added. "Getting more information and getting the precise diagnosis does not always translate into better outcomes," he said. "We must always consider the second part of the equation, which is did finding the abnormality lead to patient benefit."

SOURCE: and JAMA Pediatrics, online August 3, 2020.