Study Question: The degree of concordance between the indications and criteria for the performance of CT scans in children, and the practice of pediatricians, surgeons and orthopedists in a secondary medical center.
Background: The exposure of children to medical radiation can cause long-term risks and complications. During the years 1995-2008, the number of ER visits during which CT’s were performed in children grew 5-fold, while the overall number of visits remained constant. It is estimated that in 89.4% of pediatric CT’s in secondary medical center ER’s, insufficient consideration is paid to the need to reduce radiation exposure.
Hypothesis: Disparities exist between the accepted criteria for performing pediatric CT’s especially in the ER, particularly during on-call hours.
Methods: Medical files of children were reviewed anonymously and retrospectively. Pre-study history and physical examination were used to evaluate if the imaging study was done in concordance with accepted guidelines. The results of the imaging and their impact on treatment were examined. The correctness of doing the imaging was evaluated by a senior pediatric surgeon, the head of the orthopedics department, head of pediatrics and a senior radiologist.
Results: There was evidence of non-appropriateness as judged by accepted guidelines in approximately 45% of pediatric CT’s. There is a trend towards excess CT studies during evening on-call hours.
Discussion: Various possible causes for the observations are possible including lack of awareness among the staff and a lack of pediatric radiologists. Correction of these issues is likely to lead to a reduction in unnecessary medical radiation exposure among children.
