Children’s ERs choosing ultrasound over CT for tummy pain; general ERs encouraged to follow suit

Pediatric patients with nontraumatic abdominal 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 overall 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 began building momentum).

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

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

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

Overall use of CT and ultrasound did not significantly 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 preceding 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 dissemination 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.