Department of Radiology, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA.
Radiology. 2012 Jun;263(3):778-85. doi: 10.1148/radiol.12111726. Epub 2012 Apr 24.
To evaluate use of imaging in children with acute abdominal pain who present to U.S. emergency departments (EDs).
This study received expedited review by the institutional review board. The National Hospital Ambulatory Medical Care Survey is a government-administered yearly survey of EDs that is used to estimate ED care throughout the United States. This retrospective cohort study interrogated the database for the period from 1999 to 2007. Univariate regression analysis was performed, and a multivariate regression model was developed.
From 1999 to 2007, 16 900 000 pediatric ED visits were made for acute abdominal pain. Odds of undergoing computed tomography (CT) in this population increased during each year of the study period. No significant changes occurred in use of ultrasonography, number of patients admitted to the hospital, or number of patients with acute appendicitis. A multivariate model for CT use revealed increased odds of CT use in teens, white patients, the Midwest region, urban settings, patients with private insurance, and patients who were admitted or transferred. Odds of undergoing CT were significantly lower among patients who presented to a pediatric-focused emergency department (adjusted odds ratio, 0.72; 95% confidence interval: 0.58, 0.90).
The main findings of this study are that the rate of CT use in the evaluation of abdominal pain in children increased every year between 1999 and 2007 and that the use of CT was greater among children seen in adult-focused EDs. Factors affecting CT use include sex, race, age, insurance status, and geographic region.
评估美国急诊部（ED）中出现急性腹痛的儿童使用影像学检查的情况。
本研究经机构审查委员会快速审查。国家医院门诊医疗调查是一项由政府管理的，对 ED 进行的年度调查，用于评估全美国的 ED 护理情况。本回顾性队列研究对 1999 年至 2007 年期间的数据库进行了查询。进行了单变量回归分析，并建立了多变量回归模型。
1999 年至 2007 年，有 1690 万例儿科 ED 因急性腹痛就诊。在研究期间的每年，该人群接受计算机断层扫描（CT）的几率都有所增加。超声检查的使用率、住院患者人数或急性阑尾炎患者人数没有明显变化。CT 使用的多变量模型显示，青少年、白人患者、中西部地区、城市环境、私人保险患者以及住院或转院患者的 CT 使用几率增加。在就诊于专注于儿科的 ED 的患者中，CT 使用率显著降低（调整后比值比，0.72；95%置信区间：0.58，0.90）。
本研究的主要发现是，1999 年至 2007 年间，每年评估儿童腹痛时 CT 使用率都有所增加，并且在专注于成人的 ED 中就诊的儿童 CT 使用率更高。影响 CT 使用的因素包括性别、种族、年龄、保险状况和地理位置。
