How advance imaging utilization has changed over 10 years

The best practices for advanced imaging in emergency departments has changed dramatically over the past decade, as the drive to reduce radiation exposure has intensified. A report in JAMA Pediatrics offers a look at the trends in imaging.¹

Researchers ran a cross-sectional study that examined 26,082,062 emergency department visits. They only included visits that involved a child aged 18 years and younger. The information came from the January 2009 to December 2018. The imaging techniques examined were computed tomography, magnetic resonance imaging, and ultrasonography.

The 26,082,062 visits involved 9,868,406 children who were seen in 32 emergency departments across the United States. The proportion of emergency department visits that had any advanced imaging increased from 6.4% in 2009 to 8.7% in 2018. During the same time, the proportion of visits that utilized computed tomography went from 3.9% to 2.9%. Meanwhile, ultrasonography increased from 2.5% to 5.8% and magnetic resonance imaging increased from 0.3% to 0.6%. The major decreases in computed tomography rates occurred with concussion (−23.0%), appendectomy (−14.9%), ventricular shunt procedures (−13.3%), and headaches (−12.4%). The increased use of nonradiating imaging modalities included magnetic resonance imaging for ventricular shunt procedures (17.9%) and ultrasonography for appendectomy (42.5%) and abdominal pain (20.3%). During the study period, emergency departments had a wide variation in the utilization of magnetic resonance imaging for ventricular shunt procedures and ultrasonography for appendectomy. In the study period, hospitalization and 3-day emergency department rates decreased and the length of stay in the emergency department did not change.

The study authors concluded that overall the use of advanced imaging went up from 2009 to 2018. Ultrasonography and magnetic resonance imaging increased during the period, but the use of computed tomography went down during the period. The variation in practice seen indicate a need to develop standardized imaging practices.

Reference

1. Marin J, Rodean J, Hall M, et al. Trends in use of advanced imaging in pediatric emergency departments, 2009-2018. JAMA Pediatr. August 3, 2020. Epub ahead of print. doi:10.1001/jamapediatrics.2020.2209