Use of CT during pediatric ED visits is growing rapidly

The use of computed tomography (CT) in children who visit the emergency department (ED) is increasing at a rate comparable to that in adults, say researchers in an analysis that appears in the online edition of Radiology.

The appropriateness of this substantial increase in the use of CT in children is not known, but special attention must be given to this vulnerable population, given that children’s organs are more radiosensitive than adults’ and that when CT is performed in non-pediatric-focused EDs, radiation settings are not likely to be adjusted to children’s smaller size.

In reviewing data from the National Hospital Ambulatory Medical Care Survey, investigators found that the percentage of ED visits in patients younger than 18 years in which a CT was performed increased by 5-fold from 1995 to 2008. This increase represented an annual growth rate of 12.8%, or a doubling of the rate every 5.8 years. By comparison, the annual growth rate in patients of all ages was 14.2% over the same time.

The increase in the use of CT occurred despite a relatively constant number of pediatric visits to the ED over the study period.

Head injury was the chief complaint that generated the most CT scans over this time, followed by headache and abdominal pain. The rate of CT imaging increased the most for a chief complaint of abdominal pain. Radiation doses with CT scans of the abdomen can be up to 7 times higher than with CT scans of the head, note the researchers, which suggests that radiation dose increased even more so than the rate of increase in the percentage of ED visits in which a CT scan was done.

Almost 90% of the child ED visits associated with a CT scan occurred at non-pediatric-focused hospitals, which may be “less likely to consistently tailor the CT technique to the body size of the pediatric patient,” researchers speculate.

At a time of growing concern over the potential risks of exposure to ionizing radiation, the current findings are worrisome in that today’s children are likely to receive a higher cumulative lifetime dose of medically related radiation than current adults.

“Because of the higher susceptibility to potential effects from ionizing radiation in children compared with adults, the rapid rise in CT warrants further efforts to ensure appropriate use and dose optimization,” investigators write.

Larson DB, Johnson LW, Schnell BM, Goske MJ, Salisbury SR, Forman HP. Rising use of CT in child visits to the emergency department in the United States, 1995-2008. Radiology. 2011. Epub ahead of print.