Tiidermann Mariliis, Pihlakas Triin, Saaring Juhan, Märs Janelle, Aasmäe Jaanika, Langemets Kristiina, Lintrop Mare, Kool Pille, Ilves Pilvi
Department of Radiology, Institute of Clinical Medicine, University of Tartu, Ülikooli 18, Tartu 50090, Estonia.
Radiology Clinic, Tartu University Hospital , L. Puusepa 8, Tartu 50406, Estonia.
BJR Open. 2024 Aug 5;6(1):tzae020. doi: 10.1093/bjro/tzae020. eCollection 2024 Jan.
To analyse changes in the use of paediatric (≤16 years) CT over the past decade and to evaluate the appropriateness of CT examinations at a tertiary teaching hospital.
Data from 290 paediatric CTs were prospectively collected in 2022 and compared with data from 2017 (358 cases) and 2012 (538 cases). The justification of CTs was evaluated with regard to medical imaging referral guidelines and appropriateness rates were calculated.
Paediatric CTs decreased 39.4% over the 10 years, contrasting with a 27.6% increase in overall CTs. Paediatric CTs as the share of overall CTs dropped from 2.5% in 2012 to 1.1% in 2022 ( < .0001), with a concurrent rise in paediatric MRIs ( < .0001). Notable reductions in CT use occurred for head trauma ( = .0003), chronic headache ( < .0001), epilepsy ( = .037), hydrocephalus ( = .0078), chest tumour ( = .0005), and whole-body tumour ( = .0041). The overall appropriateness of CTs improved from 73.1% in 2017 to 79.0% in 2022 ( = .0049). In 15.4% of the cases, no radiological examination was deemed necessary, and in 8.7% of the cases, another modality was more appropriate. Appropriateness rates were the highest for the head and neck angiography (100%) and the chest (96%) and the lowest for the neck (66%) and the head (67%).
Justification of CT scans can be improved by regular educational interventions, increasing MRI accessibility, and evaluating the appropriateness of the requested CT before the examination. Interventions for a more effective implementation of referral guidelines are needed.
The focus for improvement should be CTs for head and cervical spine trauma, accounting for the majority of inappropriate requests in the paediatric population.
分析过去十年间儿科（≤16岁）CT使用情况的变化，并评估一家三级教学医院CT检查的合理性。
前瞻性收集2022年290例儿科CT的数据，并与2017年（358例）和2012年（538例）的数据进行比较。根据医学影像转诊指南评估CT检查的合理性，并计算适宜率。
儿科CT在10年间减少了39.4%，而总体CT使用量增加了27.6%。儿科CT在总体CT中所占比例从2012年的2.5%降至2022年的1.1%（P<0.0001），同时儿科MRI使用量有所增加（P<0.0001）。头部创伤（P=0.0003）、慢性头痛（P<0.0001）、癫痫（P=0.037）、脑积水（P=0.0078）、胸部肿瘤（P=0.0005）和全身肿瘤（P=0.0041）的CT使用量显著减少。CT检查的总体适宜率从2017年的73.1%提高到2022年的79.0%（P=0.0049）。在15.4%的病例中，认为无需进行放射学检查，在8.7%的病例中，另一种检查方式更为合适。头颈部血管造影（100%）和胸部（96%）的适宜率最高，颈部（66%）和头部（67%）的适宜率最低。
通过定期的教育干预、增加MRI的可及性以及在检查前评估所要求CT的合理性，可以提高CT扫描的合理性。需要采取干预措施以更有效地实施转诊指南。
改进的重点应是针对头部和颈椎创伤的CT检查，这在儿科人群中占大多数不适当的检查请求。
