Tertiary pediatric institutions differ greatly in how often they use computed tomography (CT) imaging, whether for emergency department (ED), inpatient, or observation encounters, and regardless of body region.
Tertiary pediatric institutions differ greatly in how often they use computed tomography (CT) imaging, whether for emergency department (ED), inpatient, or observation encounters, and regardless of body region. Overall use of CT imaging is decreasing, however. These were the major findings of an analysis of 2009 to 2013 data extracted from the Pediatric Health Information System (PHIS) and encompassing more than 12.5 million patient encounters and 701,644 CT scans in 30 hospitals.
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Overall, a mean of 56 scans were performed per 1000 encounters, with hospital-specific rates ranging from 26 to 108 scans per 1000 encounters. Body regions most often imaged were head (60.1%), abdomen/pelvis (19.9%), neck (8.4%), and chest (7.7%). Imaging of the abdomen/pelvis, neck, and chest were most likely in inpatient/observation encounters and head scans in ED treat-and-release situations.
Unadjusted rates of CT scanning varied nearly 4-fold between hospitals with the lowest and highest scanning rates. Case mix-All Patient Refined Diagnosis Related Group and severity-accounted for 49% of the variability and hospital volume accounted for an additional 15%, with higher volume hospitals scanning at lower rates. This leaves 36% of the variability in use of CT imaging unexplained. The authors suggest that this variability may be attributable to differences in institutional or clinician practices (Lodwick DL, et al. Pediatrics. 2015;136:e1212-e1219).
Commentary: Variation in care is a marker for a hole in our medical knowledge. Lacking clear evidence and guidelines or knowledge of both, healthcare providers make the best decision they can based on prior experience and local practice patterns. The result is many different answers instead of one best answer. Measuring variation using large, shared data sets, such as the PHIS data used here, has become a powerful tool that can be used to focus research and education across the healthcare system. This study indicates that we need to learn more about the right thing to do in considering CT imaging for children. -Michael G Burke, MD
Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.