Pediatric Scan Remains in High-Use Despite Risk Factor

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Based on a study published in the journal Pediatrics, it has been found that one quarter of children admitted with isolated headache, are placed under a single computed tomography (CT) scan.

"Use of CT scans to diagnose pediatric headache remains high despite existing guidelines, low diagnostic yield, and high potential risk,” said Andrea DeVries, PhD, from HealthCore Inc, Wilmington, Delaware, and colleagues, citing that less than 1 percent of pediatric brain abnormalities in accordance with headache as the only symptom.

For the study, researchers examined data for 15,836 children, ranging from 3 to years of age and who were admitted two or more times with isolated headache. From the subjects, it was found that 4034 (26 percent, average age of 11.8 years) received CT scans, usually (74 percent) within one month following diagnosis.pediatic ct scan

Albeit children who were admitted to the emergency department (ED) were four times more likely to receive a CT scan than those who were treated elsewhere (odds ratio [OR], 4.4; 95% confidence interval [CI], 3.96 - 4.85; P < .001). The highest number of cases (67.4 percent) were instructed by physicians outside the ED. Neurologists were 63 percent less inclined compared to other physicians to call for a scan (OR, 0.37; 95% CI, 0.31 - 0.46; P < .01).

Professor of pediatrics and chief patient safety officer at Duke University School of Medicine in Durham, North Carolina, Karen Frush, MD, claims that obstacles to diminished CT usage stems from ease of access and availability and physicians’ intention to observe all possible aspects, at times with added pressure coming from the parents. 

"CTs are readily available and easy to complete nowadays, even with small children, because the study only takes a few minutes and there is no need for sedation, as there was in the past," said Frush, who had no direct involvement in the study, but mentioned that the findings help phycians feel more confident about their diagnosis even if the data implies the risk for structural abnormalities is low.

Additionally, a general lack of agreement over what comprises a low risk factor is also up for debate.

"Training and expertise are critical from the clinical side, and we need to have more collaborative 'appropriateness criteria' and practice guidelines," said Frush, as she explains that recommendations generated by a society or organization is not blindly accepted nor appreciated by those who were not conferred with during their inception.

Frush goes on to mention the integration of decision support features for computerized instruction, facilitating amassed radiation dose tracking in patient charts, and developing clinician reward systems based on the use of evidence-based imaging rather than overall CT use.

Frush also pointed out that CT usage may have witnessed a decline, since the study’s findings were based on data from 2007 and 2008.

"There are data to suggest that [CT] utilization has decreased across all ages over the last 3 years," said Frush, naming such causes as the economic recession, ambiguity surrounding the Affordable Care Act, efforts made toward medical cost containment, and increased education/awareness of accountability for radiation exposure.

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