Harbert Allie, Bradford Kathleen, Ritter Victor, Northam Weston T, Quinsey Carolyn
School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
World Neurosurg. 2020 Jul;139:e399-e405. doi: 10.1016/j.wneu.2020.04.014. Epub 2020 Apr 16.
Reduction in use of computed tomography (CT) in favor of rapid-sequence magnetic resonance imaging (MRI) to decrease pediatric radiation exposure has varied across institutions in the United States. The aims of this study were to understand national trends in CT and rapid-sequence MRI usage and identify variables affecting imaging practices and obstacles to CT reduction.
This was a retrospective review of deidentified discharge data for children with hydrocephalus and traumatic brain injury (TBI) in the Healthcare Cost and Utilization Project Kids' Inpatient Database in 2000, 2003, 2006, 2009, 2012, and 2016. Utilization of MRI without contrast and CT was extracted using International Classification of Diseases, Ninth Revision, and International Classification of Diseases, Tenth Revision, codes. Hospital region and age cohorts were extracted and used to categorize data. χ2 tests and logistic regression were used for analysis.
Hospitalizations utilizing CT decreased (P < 0.05) and hospitalizations utilizing MRI increased (P < 0.05) overall in both diagnosis groups throughout the years analyzed. However, there was significant regional variation in imaging. The Northeast had higher CT rates (P < 0.05) and the South had lower CT rates in patients with hydrocephalus and TBI (P < 0.05). No regional variation was found for rates of MRI use in patients with TBI.
Nationwide, the average number of discharges after hospitalizations utilizing CT in patients with hydrocephalus and TBI has decreased, while discharges after hospitalizations utilizing MRI as an alternative imaging modality have increased. Despite successful overall CT reduction, significant regional variation exists within this trend showing inconsistent reduction of CT use.
在美国，为减少儿童辐射暴露，用快速序列磁共振成像（MRI）取代计算机断层扫描（CT）的做法在各机构间存在差异。本研究的目的是了解CT和快速序列MRI使用的全国趋势，并确定影响成像实践的变量以及CT减少的障碍。
这是一项对2000年、2003年、2006年、2009年、2012年和2016年医疗成本和利用项目儿童住院数据库中脑积水和创伤性脑损伤（TBI）患儿的去识别化出院数据进行的回顾性研究。使用国际疾病分类第九版和国际疾病分类第十版编码提取无造影剂MRI和CT的使用情况。提取医院所在地区和年龄队列并用于数据分类。采用χ²检验和逻辑回归进行分析。
在分析的这些年里，两个诊断组中总体上使用CT的住院病例数减少（P<0.05），使用MRI的住院病例数增加（P<0.05）。然而，成像存在显著的地区差异。在脑积水和TBI患者中，东北部的CT使用率较高（P<0.05），南部的CT使用率较低（P<0.05）。在TBI患者中，未发现MRI使用率存在地区差异。
在全国范围内，脑积水和TBI患者使用CT后的平均出院人数有所减少，而使用MRI作为替代成像方式后的出院人数有所增加。尽管总体上成功减少了CT使用，但在此趋势中仍存在显著的地区差异，表明CT使用的减少并不一致。
