Half of emergency CT requests for children may not adhere to imaging appropriateness criteria
A significant portion of imaging requests submitted for children by emergency department personnel may not be in line with the American College of Radiology’s appropriateness criteria.
This is especially true when it comes to computed tomography exams, according to new research published in Emergency Radiology. Authors of the paper caution that not following ACR’s recommendations can be especially consequential for pediatric patients.
“Children are more vulnerable than adults to radiation-induced cancer, due to their higher susceptibility to radiation and their longer expected lifespan post-radiation exposure," Biagio Solarino, MD, PhD, with the section of legal medicine at the University of Bari in Italy, and colleagues noted. "Appropriateness of diagnostic imaging represents a key performance indicator for patient safety. Nevertheless, many [studies] have shown a widespread overuse of radiological examination in clinical practice...”
This latest study assessed hundreds of imaging exam requests submitted at a large pediatric hospital to determine how many were deemed appropriate based on ACR criteria. Nearly 500 requests for exams to rule out neurological issues were analyzed, with experts seeking to gain a better understanding of what factors might influence an exam’s appropriateness in pediatric emergencies.
Many of the orders were lacking in vital clinical information; around one-fourth of the image requisitions did not contain all the required clinical information to determine whether the exam being ordered was appropriate. This was especially true in cases where children presented with headaches.
Of those that were completed, just 16% were classified as “usually appropriate,” while 30% fell under the “may be appropriate” category. In contrast, over half (54%) could be considered “usually not appropriate” based on ACR criteria.
These findings could be owed, at least in part, to the fear of missing a critical finding, the authors suggested.
“The high percentage of inappropriate exams may be attributable to defensive medicine practice, which represents a serious and common challenge all over the world,” the group explained. “Although difficult to measure precisely, it is widely believed that this practice accounts for a quarter of total imaging expenses. While this study did not specifically aim to assess the reasons for the overuse of imaging, it is important to recognize that such overuse is often linked to fear of litigation, particularly in emergency department settings.”
The team suggested that improved communication is one of numerous potential solutions to the issue of overutilization of imaging in pediatrics.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.