Use of CT Scans in Pediatric Injury Varies Widely Among Emergency Rooms, Says UPMC, Pitt Study

Emergency departments vary widely when it comes to ordering CT scans for children who come in with injuries, according to a study conducted by Children’s Hospital of Pittsburgh of UPMC and the University of Pittsburgh School of Medicine. The findings, published this month in the Journal of Pediatrics, suggest that improvement in decision making about imaging and establishing best-practice guidelines may help reduce exposure to unnecessary radiation and contain costs.

Concern has grown that patients may be exposed to harmful levels of radiation from CT scans, noted lead investigator and Children’s emergency room physician Jennifer Marin, M.D., M.Sc., who also is an assistant professor of pediatrics and emergency medicine at Pitt School of Medicine.

“Injuries are the leading cause of death in children and CT is the most accurate method we currently have available to diagnose many of these injuries. We wanted to evaluate if and to what degree CT use varied for injured children seen in the emergency department,” Dr. Marin said. “We found there was no correlation between the severity of injury and when a CT was performed.”

The team looked back at nearly 81,000 cases of injured children treated at 14 emergency departments (ED) from November 2010 to February 2013. More than 98 percent had minor injuries and were discharged to home. Doctors were more likely to order CT scans for intracranial injuries, skull and spine fractures, the researchers found. Of those visits in which a CT was performed, 28 percent were associated with more than one CT, 8 percent were associated with more than two CTs, and in some cases, up to 7 CT scans were performed.

“Emergency rooms vary widely in their use of CT scanning with some more likely to perform CT scanning than others,” Dr. Marin said. “Additionally, some are more likely to use specific types of CTs, such as cervical spine and chest CTs, which is noteworthy, given the radiation dose and radiosensitive areas like the pediatric thyroid and breast being exposed.”

She emphasized the study was not designed to look at patient outcomes or the appropriateness of CT use.

The team included Li Wang, M.S., and Daniel G. Winger, M.S., both of the University of Pittsburgh Clinical and Translational Science Institute; and Rebekah C. Mannix, M.D., M.P.H., of Boston Children’s Hospital.

The effort was funded by National Institutes of Health grant UL1TR000005.

Andrea Kunicky, 412-692-6254, andrea.kunicky@chp.edu
Anita Srikameswaran, 412-578-9193, SrikamAV@upmc.edu