Bellyaches, head bumps and pain are all ailments that children complain about and parents fret over. But do they always warrant a CT scan in the emergency room?
A new study suggests that doctors tend to think so. The number of emergency room visits in which children received a CT scan has surged — from 330,000 in 1995 to 1.65 million in 2008. The increase raises concerns about the long-term risks of radiation exposure in this vulnerable population, and underscores the importance of administering the scans judiciously.
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While the number of children’s visits to the ER did not increase much during the period researchers examined, the percentage of visits involving CT scans increased from about 1% to nearly 6%, according to the study published online Tuesday by the journal Radiology.
The most common patient complaints receiving CT scans: head injuries, abdominal pain and headaches.
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Increases in CT scanning occurred at both children’s hospitals and general hospitals, where most kids receive treatment. From 1995 to 2008, CT scans for kids at general hospitals increased from more than 300,000 to more than 1.4 million, the study found, while those at children’s hospitals increased from nearly 15,000 to more than 200,000.
The worry is that youngsters who are treated at general hospitals may be more likely to be exposed to adult-size doses of radiation, since these facilities are not as likely as children’s hospitals to reduce dosing appropriately. Kids are especially sensitive to radiation exposure not only because they’re smaller than adults, but also because they have more rapidly dividing cells and more time for radiation-related cancers to emerge.
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The rates of CT imaging have risen in part because of technological improvements, the study’s authors said. Modern scans offer fast, precise images, which make them useful in the ER. In 1995, abdominal CT scans were hardly used; in 2008, they were used in 15% to 21% of visits.
But there are other reasons. Reported the AP:
Other factors likely contributed to the increases, and in some cases, overuse, including fear of lawsuits, which drives some doctors to order tests to avoid getting sued for a missed diagnosis.
“If you send a kid home [without a CT scan] and it turns out you missed an abnormality, not many juries are going to be sympathetic,” [lead author David B.] Larson, [director of quality improvement in the department of radiology at Cincinnati Children's Hospital Medical Center in Ohio], said.
The answer isn’t to scrap CT scans, but to encourage doctors to use them more prudently. “We need to think creatively about how to partner with each other, with ordering clinicians and with CT manufacturers to ensure that all children are scanned only when it is appropriate and with appropriate techniques,” said Larson, director of quality improvement in the department of fadiology at Cincinnati Children’s Hospital Medical Center in Ohio, in a press release.
Already, physicians at many hospitals across the country have begun using ultrasound instead of CT to diagnose appendicitis in some cases of abdominal pain, according to the AP.
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Parents should inquire about the risks of CT scans and raise other questions with doctors before allowing a scan for their child. But no matter the decision, physicians should remain mindful that children’s CT scans require special oversight, particularly when it comes to adjusting doses to fit the patient’s body size, researchers said.