Jennifer R Marin1, Li Wang2, Daniel G Winger2, Rebekah C Mannix3. 1. Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: Jennifer.marin@chp.edu. 2. Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA. 3. Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA.
Abstract
OBJECTIVE: To assess variation in the use of computed tomography (CT) for pediatric injury-related emergency department (ED) visits. STUDY DESIGN: This was a retrospective cohort study of visits to 14 network-affiliated EDs from November 2010 through February 2013. Visits were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Primary outcome was CT use. We used descriptive statistics and performed multivariable logistic regression to evaluate the association of patient and ED covariates on any and body region-specific CT use. RESULTS: Of the 80 868 injury-related visits, 11.4% included CT, and 28.4% of those involved more than 1 CT. Across EDs, CT use ranged from 7.6% to 25.5% of visits and did not correlate with institutional Injury Severity Score (P = .33) or admission/transfer rates (P = .07). In multivariable analysis of nonpediatric EDs, trauma centers and nonacademic EDs were associated with CT use. Higher pediatric volume was associated with any CT use; however, there was an inverse relationship between volume and nonhead CT use. When the pediatric ED was included in multivariable modeling, the effect of level 1-3 trauma center designation remained, and the pediatric level 1 trauma center was less likely to use most body region-specific CTs. CONCLUSION: There is wide variation in CT imaging for pediatric injury-related visits not attributable solely to case mix. Future work to optimize CT utilization should focus on additional factors contributing to imaging practices and interventions.
OBJECTIVE: To assess variation in the use of computed tomography (CT) for pediatric injury-related emergency department (ED) visits. STUDY DESIGN: This was a retrospective cohort study of visits to 14 network-affiliated EDs from November 2010 through February 2013. Visits were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Primary outcome was CT use. We used descriptive statistics and performed multivariable logistic regression to evaluate the association of patient and ED covariates on any and body region-specific CT use. RESULTS: Of the 80 868 injury-related visits, 11.4% included CT, and 28.4% of those involved more than 1 CT. Across EDs, CT use ranged from 7.6% to 25.5% of visits and did not correlate with institutional Injury Severity Score (P = .33) or admission/transfer rates (P = .07). In multivariable analysis of nonpediatric EDs, trauma centers and nonacademic EDs were associated with CT use. Higher pediatric volume was associated with any CT use; however, there was an inverse relationship between volume and nonhead CT use. When the pediatric ED was included in multivariable modeling, the effect of level 1-3 trauma center designation remained, and the pediatric level 1 trauma center was less likely to use most body region-specific CTs. CONCLUSION: There is wide variation in CT imaging for pediatric injury-related visits not attributable solely to case mix. Future work to optimize CT utilization should focus on additional factors contributing to imaging practices and interventions.
Authors: Jennifer R Marin; Matthew D Weaver; Amber E Barnato; Jonathan G Yabes; Donald M Yealy; Mark S Roberts Journal: Acad Emerg Med Date: 2014-09 Impact factor: 3.451
Authors: Gregory E Tasian; Jose E Pulido; Ron Keren; Andrew W Dick; Claude M Setodji; Jan M Hanley; Rodger Madison; Christopher S Saigal Journal: Pediatrics Date: 2014-11 Impact factor: 7.124
Authors: I G Stiell; G A Wells; K L Vandemheen; C M Clement; H Lesiuk; V J De Maio; A Laupacis; M Schull; R D McKnight; R Verbeek; R Brison; D Cass; J Dreyer; M A Eisenhauer; G H Greenberg; I MacPhail; L Morrison; M Reardon; J Worthington Journal: JAMA Date: 2001-10-17 Impact factor: 56.272
Authors: David M Rubin; Cindy W Christian; Larissa T Bilaniuk; Kelly Ann Zazyczny; Dennis R Durbin Journal: Pediatrics Date: 2003-06 Impact factor: 7.124
Authors: Diana L Miglioretti; Eric Johnson; Andrew Williams; Robert T Greenlee; Sheila Weinmann; Leif I Solberg; Heather Spencer Feigelson; Douglas Roblin; Michael J Flynn; Nicholas Vanneman; Rebecca Smith-Bindman Journal: JAMA Pediatr Date: 2013-08-01 Impact factor: 16.193
Authors: Elisabeth T Tracy; Brian R Englum; Andrew S Barbas; Carolyn Foley; Henry E Rice; Mark L Shapiro Journal: J Pediatr Surg Date: 2013-06 Impact factor: 2.545
Authors: M Katherine Henry; Mark R Zonfrillo; Benjamin French; Lihai Song; Chris Feudtner; Joanne N Wood Journal: Acad Pediatr Date: 2016-02-04 Impact factor: 3.107
Authors: Judy R Rees; Julie E Weiss; Bruce L Riddle; Karen Craver; Michael Scot Zens; Maria O Celaya; Janet L Peacock Journal: Cancer Epidemiol Biomarkers Prev Date: 2022-10-04 Impact factor: 4.090
Authors: Jennifer R Marin; Jonathan Rodean; Matt Hall; Elizabeth R Alpern; Paul L Aronson; Pradip P Chaudhari; Eyal Cohen; Stephen B Freedman; Rustin B Morse; Alon Peltz; Margaret Samuels-Kalow; Samir S Shah; Harold K Simon; Mark I Neuman Journal: JAMA Netw Open Date: 2021-01-04