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EDs Reducing Pediatric CT Scans, Partly Because of Cancer Concerns

CINCINNATI – Pediatric emergency departments are reducing use of computed tomography (CT) scans for common childhood diagnoses including seizure, concussion, appendectomy and upper respiratory tract infection.

Instead, EDs and other hospital departments are employing alternate types of imaging, such as ultrasound and magnetic resonance imaging (MRI), for eight of 10 common diagnoses, according to an article published recently in the journal Pediatrics.

Study authors, led by researchers from Cincinnati Children’s Hospital Medical Center, posit that the decline in CT usage might be linked to evidence that ionizing radiation from CT scans leads to an increased risk of cancer in patients. Another factor, they suggest, is that electronic health records now allow for easier transfer of medical data and images, which could limit the need for duplicate scans.

"This study reinforces the pediatric community's commitment to think about both immediate and long term risks and benefits of our treatment," said lead investigator Michelle Parker, MD. "Minimizing potential for harm to our patients as we work to heal them should always remain a priority."

While CT scans provide more detail than conventional X-rays, they also emit 100 to 1,000 times more ionizing radiation, according to background information in the article. The report cites previously published literature raising the possible of one malignancy among every 10,000 children as a result of ionizing radiation in those exposed to CT scans.

Young patients requiring sophisticated imaging for diagnostic purposes might now be more likely to have an MRI, which uses magnetic fields, or ultrasound, which uses high frequency sound waves to show internal body images in real time, according to study authors.

"There may still be times when a CT scan is the most appropriate imaging tool to use, however parents should be encouraged by this study which shows that physicians and hospitals are likely incorporating new evidence and adapting to provide safe medical care ," Parker said.

For the study, the researchers used data from the Children's Hospital Association's Pediatric Health Information System, a comparative pediatric database of clinical and resource utilization information for inpatient, ambulatory surgery, ED and observation unit patient encounters for 45 children's hospitals.

Records of inpatients and observation patients for 10 specific diagnoses at 33 participating hospitals were analyzed from Jan. 1, 2004, to Dec. 31, 2012. The 10 diagnoses analyzed for imaging use included seizure, ventricular shunt procedure, craniotomy, concussion, severe head trauma, appendectomy, gastroenteritis, abdominal pain, upper respiratory tract infection and ENT conditions.

“For all included APR-DRGs except ventricular shunt procedures and nonbacterial gastroenteritis, the number of children imaged with any modality increased,” study authors conclude. “CT utilization decreased for all APR-DRGs (P values < .001). For each of the APR-DRGs except seizure and infections of upper respiratory tract, the decrease in CT was associated with a significant rise in an alternative imaging modality (P values ≤ .005).”