PURPOSE: Children are particularly vulnerable to the harmful effects of medical radiation, and children with urolithiasis are one group who may receive repeated radiation-intensive imaging tests.
Our study aimed to characterize imaging practices for children presenting to the emergency department (ED) with suspected urolithiasis (SU) and determine factors associated with the choice of imaging study.
METHODS: Using the 2006-10 Nationwide Emergency Department Sample (NEDS), we conducted a retrospective cohort study of patients < 18 years old presenting with SU. We determined imaging practices for visits in EDs where billing codes for computed tomography (CT) and ultrasound were reliably reported. Logistic regression was used to delineate patient- and hospital-level factors associated with the use of CT vs. ultrasound.
RESULTS: There were 18096 pediatric SU visits in the 1191 NEDS EDs with reliable imaging codes. Of the 11215 patients receiving a CT alone, an ultrasound alone, or both, 9773 (87%) were imaged with CT alone. CT use peaked in 2007, and declined thereafter. On multivariate analysis, the following factors were associated with the use of CT alone: lower proportion of pediatric patients treated in the ED, older age, location in the Midwest or South, evaluation at a non-teaching hospital, and visit on a weekend.
CONCLUSIONS: CT use is highly prevalent for children presenting with SU. The lowest CT use is in EDs that care for more children. Ultrasound is used very infrequently regardless of site. Awareness regarding risks of CT and consideration of alternatives including ultrasound are warranted in caring for these patients.
Written by:
Johnson EK, Graham DA, Chow JS, Nelson CP. Are you the author?
Department of Urology, Boston Children's Hospital, Boston, MA; Department of Harvard-wide Pediatric Health Services Research Fellowship, Boston Children's Hospital, Boston, MA; Center for Patient Safety & Quality Research, Boston Children's Hospital, Boston, MA; Department of Radiology, Boston Children's Hospital, Boston, MA.
Reference: J Urol. 2014 Feb 8. pii: S0022-5347(14)00050-0.
doi: 10.1016/j.juro.2014.01.028
PubMed Abstract
PMID: 24518772
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