Department of Emergency Medicine, Alameda County Medical Center-Highland Hospital, 1411 E 31st St, Oakland, CA 94602, USA.
Pediatrics. 2012 Nov;130(5):e1069-75. doi: 10.1542/peds.2012-0739. Epub 2012 Oct 8.
To evaluate trends in and factors associated with computed tomography (CT) use among children presenting to the emergency department (ED) with abdominal pain.
This study was a cross-sectional, secondary analysis of the National Hospital Ambulatory Medical Care Survey data from 1998 to 2008. We identified ED patients aged <19 years with abdominal pain and collected patient demographic and hospital characteristics, and outcomes related to imaging, hospital admission, and diagnosis of appendicitis. Trend analysis was performed over the study period for the outcomes of interest, and a multivariate regression model was used to identify factors associated with CT use.
Of all pediatric ED visits, 6.0% were for abdominal pain. We noted a rise in the proportion of these patients with CT use, from 0.9% in 1998 to 15.4% in 2008 (P < .001), with no change in ultrasound/radiograph use, diagnosis of appendicitis, or hospital admission. Older and male patients were more likely to have a CT scan, whereas black children were one-half as likely to undergo a CT scan compared with white children (odds ratio: 0.50 [95% confidence interval: 0.31-0.81]). Admitted children had much higher odds of undergoing a CT scan (odds ratio: 4.11 [95% confidence interval: 2.66-6.35]). There was a plateau in CT use in 2006 to 2008.
There was a dramatic increase in the utilization of CT imaging in the ED evaluation of pediatric patients with abdominal pain. Some groups of children may have a differential likelihood of receiving CT scans.
评估儿童因腹痛就诊于急诊（ED）时计算机断层扫描（CT）使用的趋势及其相关因素。
这是一项对 1998 年至 2008 年国家医院门诊医疗调查数据进行的横断面、二次分析研究。我们确定了年龄<19 岁、有腹痛症状的 ED 患者，并收集了患者的人口统计学和医院特征以及与影像学、住院和阑尾炎诊断相关的结果。对研究期间感兴趣的结果进行趋势分析，并使用多变量回归模型来确定与 CT 使用相关的因素。
在所有儿科 ED 就诊中，6.0%是因腹痛。我们注意到，这些患者中使用 CT 的比例有所上升，从 1998 年的 0.9%上升到 2008 年的 15.4%（P<0.001），而超声/射线照相检查、阑尾炎诊断或住院治疗的使用率并未改变。年龄较大和男性患者更有可能进行 CT 扫描，而与白人儿童相比，黑人儿童接受 CT 扫描的可能性低一半（比值比：0.50 [95%置信区间：0.31-0.81]）。住院患儿进行 CT 扫描的可能性要高得多（比值比：4.11 [95%置信区间：2.66-6.35]）。2006 年至 2008 年，CT 使用率趋于平稳。
在 ED 评估有腹痛的儿科患者时，CT 成像的使用率大幅增加。某些群体的儿童可能会有不同的接受 CT 扫描的可能性。
