Rationale and Objectives
Falls are a common cause of emergency department (ED) visits in the United States. We evaluated trends in computed tomography (CT) utilization for pediatric fall victims in the United States from 2001 to 2010.
Materials and Methods
Using the National Hospital Ambulatory Medical Care Survey from 2001 to 2010, we identified all visits of pediatric (aged <18 years) patients presenting to EDs after falls. This database surveys approximately 500 EDs per year for 4 weeks providing national estimates on ED resource utilization and outcomes. We studied trends in CT utilization and proportion of visits with life-threatening conditions after falls. We also studied the association between CT utilization rates and demographic characteristics and admission status.
Results
A total of 9763 unweighted observations for a total of 32,432,686 pediatric fall patients were seen in US EDs from 2001 to 2010. The proportion of pediatric fall patients receiving CT increased from 5.3% in 2001 to a peak of 16.6% in 2009 and decreased to 11.3% in 2010, whereas the proportion of pediatric fall patients with life-threatening conditions fluctuated between 1.2% and 3.3% during this period. In multivariate logistic regression analysis, each increasing year was independently associated with CT utilization (odds ratio [OR], 1.15; 95% confidence interval [CI], 1.14–1.16). Patients aged 0–1 years had higher odds of CT utilization than patients aged 13–17 years (OR, 2.27; 95% CI, 2.26–2.27).
Conclusions
There was a twofold increase in CT utilization among pediatric fall visits from 2001 to 2010. When controlling for demographic and clinical variables, increasing year was independently associated with CT utilization. These findings suggest that CT may be overutilized among pediatric fall patients.
Computed tomography (CT) utilization in the pediatric population has seen a rapid increase over the past decade in pediatric emergency departments (EDs) . It is estimated that at least 4 million CT scans are conducted each year on children in the United States . Diagnostic capability, wider availability, and prompt results make CT a preferred method of imaging in EDs across the United States . Falls account for the most ED visits in the pediatric population with relatively high rates of morbidity and mortality .
Recent studies indicate that nearly a quarter of all CTs ordered are inappropriate, thus subjecting patients to unnecessary radiation exposure . This is particularly concerning in the pediatric population, placing them at a potential risk for cancer, a risk that is cumulative over the patient’s lifetime . Furthermore, unnecessary imaging is a significant contributor to the rising cost of health care in the United States . Because of these issues of safety and inappropriate use and cost, we undertook a study to evaluate CT utilization trends in the pediatric population and study the associated demographic and clinical features.
Material and methods
Patient Population
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Outcomes
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Statistical Analysis
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Results
Patient Population
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Table 1
Univariate Analysis of Variables Associated with Computed Tomography Imaging
Attribute Patients Presenting with Fall, N (%) Presenting with Fall Who Are Also Receiving CT Imaging, N (%) Odds Ratio (95% Confidence Interval) Age (years) 0–1 4,716,880 (14.4) 684,887 (14.5) 1.56 (1.55–1.56) 2–5 9,238,272 (28.3) 804,689 (8.7) 0.93 (0.92–0.93) 6–12 11,379,168 (34.8) 873,404 (7.7) 0.81 (0.81–0.81) 13–17 7,324,462 (22.4) 683,347 (9.3) Ref Gender Female 13,192,248 (40.4) 1,260,621 (9.6) Male 19,466,534 (59.6) 1,785,706 (9.2) 0.96 (0.95–0.96) Insurance status Private 16,719,694 (52.8) 1,618,127 (9.7) Ref Medicaid 10,281,238 (32.5) 953,315 (9.3) 0.95 (0.95–0.96) Self-pay 2,711,403 (8.6) 204,450 (7.5) 0.76 (0.76–0.76) Ethnicity White 22,407,019 (68.6) 2,094,860 (9.4) Ref Black 5,631,363 (17.2) 479,026 (8.5) 0.90 (0.90–0.90) Hispanic 3,397,591 (10.4) 348,655 (10.3) 1.11 (1.10–1.11) Other 1,222,809 (3.7) 123,786 (10.1) 1.09 (1.08–1.10) Admission No 32,109,068 (98.3) 2,884,419 (9.0) 4.23 (4.21–4.26) Yes 549,714 (1.7) 161,908 (29.5) Life-threatening injury No 31843166 (97.5) 2763996 (8.7) 5.57 (5.54–5.60) Yes 815616 (2.5) 282331 (34.6) Arrival method No ambulance 17983261 (93.2) 1437118 (8.0) 2.90 (2.89–2.91) Ambulance 1310740 (6.8) 263712 (20.1)
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Trends in CT Utilization and Hospital Admission
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Variables Associated with CT Utilization
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Table 2
Multivariate Analysis
Attribute Odds Ratio (95% Confidence Interval) ∗ Age (years) 0–1 2.27 (2.26–2.27) 2–5 1.01 (1.01–1.02) 6–12 0.92 (0.92–0.93) 13–17 Ref Male versus female 0.86 (0.86–0.86) Insurance status Private Ref Medicaid 0.90 (0.89–0.90) Self-pay 0.55 (0.55–0.55) Ethnicity White Ref Black 0.98 (0.98–0.99) Hispanic 1.14 (1.14–1.15) Other 1.14 (1.13–1.15) Arrival in ambulance 2.30 (2.29–2.31) Admitted versus not admitted 3.25 (3.22–3.28) Year (unit change) 1.15 (1.14–1.16) Year (over range) 2.21 (2.20–2.22) Life-threatening condition 3.78 (3.76–3.80)
Analysis adjusted for age, gender, insurance status, ethnicity, arrival in ambulance, hospital admission, year, and presence of life-threatening condition.
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Discussion
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Limitations
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Conclusions
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