Emerging research suggests that overutilization of computed tomography (CT) scans is a significant issue in evaluation of pediatric patients in an emergency department setting.
For the study, recently published in Emergency Radiology, researchers reviewed data from 462 CT requests for neurological assessments at the emergency department of a pediatric hospital in Italy, and evaluated the CT requests for appropriateness as per the pediatric panel of the American College of Radiology (ACR) appropriateness criteria.
For the 348 cases with complete CT requests, the researchers found that 54 percent were “usually not appropriate” as per the aforementioned ACR criteria, 29.9 percent of CT requests “may be appropriate” and 16.1 percent were acknowledged as “usually appropriate.”
“The study highlighted the excessive and often inappropriate use of computed tomography (CT) for neurologic diseases in a pediatric emergency department, leading to an increased risk of radiation overexposure in children,” noted lead study author Michelle Carella, MD, who is affiliated with the Section of Cardiology at the University of Foggia in Foggia, Italy, and colleagues.
The “usually not appropriate” finding with CT orders occurred in 87.1 percent of seizure cases, according to the study authors. They also pointed out that inappropriate CT requests were made in 57.7 percent of cases involving a headache and 41.7 percent of head trauma cases.
Three Key Takeaways
• High rate of inappropriate CT use. Over half (54 percent) of pediatric neurologic CT requests in the ED were deemed “usually not appropriate” per ACR criteria, highlighting substantial overutilization and avoidable radiation exposure.
• Particularly low-value in common presentations. Inappropriate CT use was especially high for seizures (87.1 percent), as well as headache (57.7 percent) and head trauma (41.7 percent), reinforcing the need for stricter adherence to evidence-based imaging guidelines in these scenarios.
• Poor clinical documentation drives misuse. Nearly 25 percent of requests lacked adequate clinical information, often omitting key elements (history, symptom details, diagnostic question) that can undermine appropriate imaging selection and suggests a target for quality improvement interventions.
The researchers noted that nearly a quarter of the 462 CT requests (24.7 percent) had ambiguous or incomplete data. Over 43 percent of cases involving a headache lacked sufficient clinical information, according to the study. The three cornerstones of an imaging request should include the clinical question to be answered, appropriate localization of signs/symptoms and relevant clinical history details.
“All the lacking requests provided an insufficient clinical history. Many requests simply outline the clinical case with the statement ‘examination requested by neurology specialist’ or similar. As a consequence, clinical details, such as duration, intensity, the presence or absence of accompanying symptoms, signs, and diagnostic suspicions, are often omitted,” maintained Carella and colleagues.
(Editor’s note: For related content, see “Can AI Triage for CT Detection of Intracranial Hemorrhages Have an Impact for Pediatric Patients?,” “CT Radiation Exposure and Hematologic Cancers in Children: An Interview with Rebecca Smith-Bindman, MD” and “Study: Photon-Counting CT Reduces Radiation Dosing by More than 40 Percent in Kids with Congenital Heart Disease.”)
In regard to study limitations, the authors acknowledged that a single trainee operator evaluated the cases for appropriateness against the ACR appropriateness criteria and conceded a lack of analysis of the CT exams performed after the requests for imaging.
