Emergency room CT scanning of teenagers skyrockets

The number of emergency department pediatric CT studies performed in such clinical areas as chest imaging may have increased more than 400% in less than a decade, according to University of North Carolina researchers. Adolescents are particularly vulnerable.

Mounting evidence in the clinical literature suggests that the utilization rate of CT scans of the adult population presenting to the emergency department has outgrown ER patient volume. Meanwhile, several studies have gained the attention of radiologists and other physicians regarding the risks associated with CT radiation exposure over time.

Based on this information, a group of UNC researchers sought to establish whether the CT utilization trend in adults had crossed over to the pediatric population. They hypothesized that the utilization rate in ER pediatric patients had not increased at the same rate mostly because of the growing awareness of radiation exposure risks.

Instead, they found that pediatric CT utilization, particularly in adolescent patients, had increased at a rate that far exceeds the growth in emergency department visits, said principal investigator Dr. Joshua Broder, an emergency physician at UNC at the time of the study. Broder presented the findings at the 2007 RSNA meeting.

Broder and colleagues retrospectively reviewed a database including 78,932 pediatric patients who presented to the emergency department between 2000 and 2006. The investigators identified 4138 patients who underwent 6073 scans during this period. They broke down findings by imaging categories and patient age group and compared the data with ER volumes and severity of the diagnosis as defined by a triage acuity score.

Total pediatric emergency department volume during this period increased by 2%, while triage acuity scores remained stable. During this same time period, CT scanning increased by 23% in the head, 366% in the cervical spine, 435% in the chest, and 49% in the abdomen. Miscellaneous CT scans rose by 96%.

Increases in CT utilization were most pronounced in adolescents aged 13 to 17. CT utilization rates in this age group were similar to or exceeded those seen in the adult population. The rate in children younger than 13 was substantially smaller.

The study also showed a correlation between the increase in CT scans in adolescents and an increase in the number of trauma cases from this age group. Although this finding does not fully explain why these increases in CT utilization occur, it suggests that adolescents are being managed like adults in many cases, Broder said. More studies are needed to elucidate this and other questions raised by the study. He pointed out, however, that the current study, by identifying the areas of pediatric emergency medicine where CT utilization is high, could help physicians limit the number of unwarranted CT scans.

Just like radiologists, emergency department physicians worry about the cumulative radiation risk to these patients. They are also concerned, however, about the imminent threat from whatever pathology they consider at any given time. It's a balancing act, since in any given situation the imminent threat may seem much graver and more likely than the delayed risk from radiation, Broder said.

"Better tools are needed in the clinical environment to help us select which patients do and don't need emergency CT imaging," he said.

For more information from the Diagnostic Imaging archives:

Image Gently alliance seeks to reduce pediatric CT radiation dose

Contrast ultrasound proves as accurate as CT for assessing abdominal trauma in children

Pediatric CT dose reduction strategies get global focus

Dose-saving strategies play catch up to greater CT use