Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
Pediatrics. 2012 Mar;129(3):e690-7. doi: 10.1542/peds.2011-2548. Epub 2012 Feb 13.
The purpose of this study was to determine the overall trend of computed tomography (CT) utilization in the pediatric emergency department (PED) from 2003 to 2010 and to determine trends categorized by common chief complaints.
Electronic chart records at 2 tertiary care PEDs within a large pediatric health care system were reviewed from January 2003 through December 2010. The annual CT utilization rate, by anatomic location, was determined. Annual CT utilization rates were compared with alternative imaging trends for visits with chief complaints of head injury, seizure, and abdominal pain. Analysis was performed with linear regression.
There was no change in overall CT utilization from 2003 to 2010 (β 0.25, 95% confidence interval [CI] [-1.61 to 2.73]) or within anatomic subgroups. Head CT utilization for the chief complaints of seizure (β -0.97, 95% CI [-1.44 to -0.90]) and head injury (β -0.93, 95% CI [-1.71 to -0.73]) showed significant declines. Although there was no change in the abdominal CT utilization rate for abdominal pain, abdominal ultrasound utilization for abdominal pain significantly increased (β 0.89, 95% CI [0.25-0.79]).
Our data showed no overall increase in CT utilization through 2010. In areas where alternative non-radiation-based modalities were options, there were decreased CT trends and increased use of potential alternative non-radiation-based modalities. This is the first large PED cohort study to show a decrease in CT utilization in recent years in a regional pediatric referral center and may correlate with increased awareness of radiation risk in children.
本研究旨在确定 2003 年至 2010 年期间儿科急诊部（PED）计算机断层扫描（CT）使用的总体趋势，并确定按常见主诉分类的趋势。
回顾了一家大型儿科医疗保健系统内的 2 家三级护理 PED 的电子图表记录，时间从 2003 年 1 月至 2010 年 12 月。确定了按解剖部位划分的年度 CT 使用率。比较了以头痛、癫痫和腹痛为主要症状的就诊者的年度 CT 使用率与其他影像学趋势。采用线性回归进行分析。
2003 年至 2010 年期间，总体 CT 使用量没有变化（β0.25，95%置信区间[CI][-1.61 至 2.73]）或在解剖亚组内没有变化。对于癫痫（β-0.97，95%CI[-1.44 至-0.90]）和头部受伤（β-0.93，95%CI[-1.71 至-0.73]）的主要症状，头部 CT 使用率显著下降。尽管腹痛的腹部 CT 使用率没有变化，但腹部超声检查的使用率明显增加（β0.89，95%CI[0.25-0.79]）。
我们的数据显示，2010 年 CT 使用率没有总体增加。在可以选择其他非放射性方式的情况下，CT 使用率呈下降趋势，而潜在的替代非放射性方式的使用有所增加。这是第一个在区域儿科转诊中心显示近年来 CT 使用量减少的大型 PED 队列研究，可能与儿童对辐射风险的认识提高有关。
