The use of computed tomography in children’s hospitals appears to be on the decline across the top 10 all-patient-refined, diagnosis-related groups (APR-DRGs), with alternate imaging processes increasing in utilization for 8 of those 10 groups.
New research examining the use of CT scans on children admitted to 33 pediatric tertiary-care hospitals participating in the Pediatric Health Information System between Jan. 1, 2004, and Dec. 31, 2012, reveals the decrease (Pediatrics 2015 Aug 24.[doi: 10.1542/peds.2015-0995]).
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“This decrease occurred with a concomitant increase in alternative imaging modalities in 8 studied diagnostic groups, supporting the hypothesis that previously noted declines in CT utilization are associated with shifts to alternate modalities,” Dr. Michelle W. Parker of Children’s Hospital Medical Center in Cincinnati and her colleagues wrote.
The 10 APR-DRGs studies are:
• seizure.
• ventricular shunt procedures.
• appendectomy.
• craniotomy except for trauma.
• concussion, closed skull fracture, uncomplicated intracranial injury, coma less than 1 hour or no coma (concussion).
• head trauma with coma greater than 1 hour or hemorrhage (severe head trauma).
• infections of upper respiratory tract.
• nonbacterial gastroenteritis with nausea and vomiting (gastroenteritis).
• abdominal pain.
• other ear, nose, mouth, throat, and craniofacial diagnoses.
“The decrease was most noted for patients with an APR-DRG of seizure where CT utilization decreased almost 50%, and MRI utilization decreased by greater than 10%,” the authors wrote.
Severe head trauma had the largest reduction in CT utilization. “MRI utilization could not be evaluated for appendectomy, gastroenteritis, or infections of the upper respiratory tract because of limited study volume. Statistically significant changes in MRI use were noted across the remaining APR-DRGs,with marked increases for ventricular shunt procedures,” Dr. Parker and her colleagues reported.
“There were no ultrasound studies meeting inclusion criteria for seizures, concussion, or severe head trauma. Ultrasound use increased during the study period for all other APR-DRGs, with the greatest increase noted in appendectomy and gastroenteritis,” they said.
Dr. Parker and her colleagues suggested a number of reasons for the decrease, including a 2006 effort by the Alliance for Radiation Safety in Pediatric Imaging, an initiative within the Society for Pediatric Radiology that raised awareness on the number of pediatric CT scans and the use of adult dose protocols in pediatric imaging. They also mentioned other technological advances, such as electronic health records and the sharing of existing images, which may have contributed to the lower utilization of CT scans.
The authors note that the decrease does have public health implications, as lower CT utilization decreases exposure to hazardous ionizing radiation.“Therefore, the substitution of an imaging modality that does not confer ionizing radiation may affect lifetime cancer risk in children who receive diagnostic imaging.”
Dr. Parker and her colleagues reported no conflicts of interest or external funding sources for the research.