This Viewpoint discusses overuse of pediatric imaging and the need for standardization of care, measurement, and accountability.
This database review reports that use of diagnostic ultrasonography has increased and that of computed tomography has decreased in children with suspected appendicitis, resulting in a decline in negative appendectomy at 35 pediatric institutions.
This review illustrates the potential for useful application of pediatric point-of-care ultrasound in many clinical and educational settings.
To determine population-based rates of the use of diagnostic imaging procedures with ionizing radiation in children, stratified by age and sex.
Retrospective cohort analysis.
All settings using imaging procedures with ionizing radiation.
Individuals younger than 18 years, alive, and continuously enrolled in UnitedHealthcare between January 1, 2005, and December 31, 2007, in 5 large US health care markets.
Number and type of diagnostic imaging procedures using ionizing radiation in children.
A total of 355 088 children were identified; 436 711 imaging procedures using ionizing radiation were performed in 150 930 patients (42.5%). The highest rates of use were in children older than 10 years, with frequent use in infants younger than 2 years as well. Plain radiography accounted for 84.7% of imaging procedures performed. Computed tomographic scans—associated with substantially higher doses of radiation—were commonly used, accounting for 11.9% of all procedures during the study period. Overall, 7.9% of children received at least 1 computed tomographic scan and 3.5% received 2 or more, with computed tomographic scans of the head being the most frequent.
Exposure to ionizing radiation from medical diagnostic imaging procedures may occur frequently among children. Efforts to optimize and ensure appropriate use of these procedures in the pediatric population should be encouraged.
Freedman et al determine whether increasing emergency department ondansetron use has resulted in a reduction in intravenous rehydration rates. Keren provides commentary in a related editorial.