Pediatric head CT rates remain high despite ongoing efforts

Pediatric CT neuroimaging has not decreased in the last decade despite ongoing efforts to identify children with traumatic brain injury (TBI) who should avoid scans, according to research published online in the September issue of Pediatrics.  

Efforts such as those by the Image Gently Alliance and the Pediatric Emergency Care Applied Research Network (PECARN) have aimed to reduce inappropriate CT use for pediatric head trauma patients. However, concerns regarding safety and costs remain, wrote lead author Brett Burnstein, MD, of the division of pediatric emergency medicine at Montreal Children’s Hospital in Canada, and colleagues.  

“Excess CT use contributes to rising health care costs, exposes many children to the harmful effects of ionizing radiation and for some, the additional risks of sedation required for imaging,” the researchers wrote.  

For the study, the researchers analyzed data from the National Hospital Ambulatory Care Medical Survey database. The data included pediatric patients evaluated for 14.3 million cases of TBI from 2007 to 2015.  

The researchers found 32 percent of children underwent CT neuroimaging between 2007 and 2015 with no significant annual linear trend from year to year. Age, higher triage acuity and presentation to nonteaching or non-pediatric hospitals were variables researchers identified that are associated with this increased use of CT neuroimaging.  

Additionally, white patients were significantly associated with increased odds of CT neuroimaging, according to the researchers.  

“Identifying patient and provider groups that are most likely to benefit from targeted quality initiatives to reduce CT overuse remains an important area of future research,” the researchers wrote. “Results from this large nationally representative study suggest a need for targeted quality improvement initiatives to ensure appropriate CT use in this [pediatric] patient population."