Children’s ERs choosing ultrasound over CT Scans for abdominal pain; general ERs encouraged to follow trend

Pediatric patients with nontraumatic stomach pain are less likely to receive CT scans—and more likely to be imaged with ultrasound instead—in pediatric emergency departments than their peers taken to general emergency departments (EDs).

And the general use of abdominal CT for children and adolescents has leveled off across the board since 2007 when the orders hit a high-water mark after rising for nearly a decade (and when the Image Gently campaign started building momentum).

These are the key findings uncovered by a review of data reflecting more than 20 million pediatric ED visits conducted at George Washington University in the nation’s capital and issued online Sept. 15, 2017, in Pediatrics.

Lauren Niles, MPH, Joanna Cohen, MD, and colleagues used data from the CDC’s National Hospital Ambulatory Medical Care Survey. Their principal interest was in recognizing trends in the use of ultrasound versus CT in pediatric-specific and common ED settings.

Performing multivariable logistic regression to measure the strength of the association of ED type, and altering for potential confounding variables, the team additionally found that, in both settings combined, 14.6% of patients received CT only, 10.9% received ultrasound only, and 1.9% had both.

General use of CT and ultrasound did not meaningfully change over the study period, 2007 through 2014.

“CT imaging for pediatric patients with nontraumatic abdominal pain has plateaued since 2007 after the steady increase seen in the previous nine years,” the authors write. “Among this

population, an increased likelihood of CT imaging was demonstrated in general EDs compared with pediatric EDs, in which there was a higher likelihood of ultrasound imaging.”

Niles et al. call for wider distribution of pediatric imaging protocols to general EDs as a way to keep radiation exposure top of mind for children no matter where they’re taken for emergency care.

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