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General EDs More Likely to Use CT to Diagnose Pediatric Abdominal Pain

Computed tomography (CT) scans are more likely to be used in a general emergency department (ED) to diagnosis children with nontraumatic abdominal pain than in an ED specializing in pediatrics, according to a new study.

The report in the journal Pediatrics points out that while overall use of CT in pediatric nontraumatic abdominal pain has leveled off since 2011, there is still significant variation regarding where the imaging technology is most often employed.

“An estimated 21.1 million emergency department visits for children with abdominal pain occur each year, and 80 percent of those are seen in the general emergency departments,” explained senior author Joanna Cohen, MD, a pediatric emergency physician at Children's National Health System. “Similar patients seen in pediatric emergency departments with these symptoms are less likely to receive a CT scan and therefore less likely to incur the radiation exposure that accompanies CT.”

Pediatric EDs were more likely to use ultrasound for diagnosis, which is recommended in current pediatric clinical practice guidelines to reduce unnecessary radiation exposure to children. Ultrasounds aren’t as precise as CT, but usually are effective enough for a diagnosis, point out study authors. This results in a much smaller number of patients requiring CT when ultrasound is not definitive enough.

Researchers used data from the National Hospital Ambulatory Medical Care Survey for a repeat cross-sectional analysis of national ED trends in CT and ultrasound imaging for pediatric nontraumatic abdominal pain. The study, which analyzed ED data from 2007 through 2014, reveals that CT use hasn’t varied much since 2011. From 1999 to 2009, use of the imaging was steadily increasing.

Results indicate that, of about 21.1 million ED visits for nontraumatic abdominal pain, 14.6% of children had CT imaging only, 10.9 had ultrasound imaging only, and 1.9% received both CT and ultrasound. CT use was lower among children treated in pediatric EDs compared with general EDs for an adjusted odds ratio of 0.34. At the same time, ultrasound use was higher among children treated in pediatric EDs compared with general EDs, for an adjusted odds ratio of 2.14.

“This study has shown us two things: first, national awareness of the risks of radiation exposure for children may now be influencing national imaging trends in a positive way,” Cohen said. “And second, encouraging the dissemination of pediatric focused radiology protocols to general EDs may help further advance this trend.”

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