Increasing utilization of computed tomography in the pediatric emergency department, 2000-2006
Increasing utilization of computed tomography in the pediatric emergency department, 2000-2006
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DOI：
10.1007/s10140-007-0618-9
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发表时间：
2007-09-01
影响因子：
2.2
通讯作者：
Warshauer, David M.
中科院分区：
文献类型：
--
作者：
Broder, Joshua;Fordham, Lynn Ansley;Warshauer, David M.
这项研究的目的是描述儿科急诊科(ED)6年来计算机断层扫描(CT)使用的变化。对2000年7月至2006年7月间0-17岁儿童ED患者的CT扫描进行了分析，分为五组：头部、颈椎、胸部、腹部和其他。测定儿童ED患者的数量和分诊敏锐度评分。在研究期间，急诊室的4,138名儿科患者共接受了6,073次CT扫描。在同一时期，78,932名儿科患者在急诊室接受了评估。从2000年到2006年，儿科ED患者数量增加了2%，而分诊敏感度保持稳定。在同一时期，头部CT增长了23%，颈椎CT增长了366%，胸部CT增长了435%，腹部CT增长了49%，杂项CT增长了96%。CT使用率的增加在13至17岁的青少年中最为明显。这一年龄段CT使用率的增长达到或超过了成人人口的增长。在13岁以下的儿童中，增加的幅度要小得多。儿童ED CT使用率的增长速度远远超过了ED患者数量的增长，这与成人的趋势相似。尽管医学文献中对CT在儿科人群中的辐射风险进行了大量讨论，但这一增长还是发生了，这可能反映了CT的可用性增加，CT诊断能力的提高，以及医生和患者对诊断确定性的渴望增加。这种更高的利用率是否会改善患者的预后尚不确定，值得进一步研究。
The objective of this study is to characterize changes in computed tomography (CT) utilization in the pediatric emergency department (ED) over a 6-year period. CT scans ordered on pediatric (ages 0 to 17 years) ED patients from July 2000 to July 2006 were analyzed in five groups: head, cervical spine, chest, abdomen, and miscellaneous. Pediatric ED patient volume and triage acuity scores were determined. There were 6,073 CT scans performed on 4,138 pediatric patients in the ED during the study period. During this same period, 78,932 pediatric patients were evaluated in the ED. From 2000 to 2006, pediatric ED patient volume increased by 2%, while triage acuity remained stable. During this same period, head CT increased by 23%, cervical spine CT by 366%, chest CT by 435%, abdominal CT by 49%, and miscellaneous CT by 96%. Increases in CT utilization were most pronounced in adolescents ages 13 to 17 years. Increases in CT utilization in this age group met or exceeded increases seen in the adult population. In children less than 13 years of age, increases were substantially smaller. Pediatric ED CT utilization particularly in the adolescent population has increased at a rate far exceeding the growth in ED patient volume, mimicking the adult trend. This increase has occurred despite considerable discussion in the medical literature about the radiation risks of CT in the pediatric population and may reflect increased availability of CT, improvements in CT diagnostic capabilities, and increased desire on the part of physicians and patients for diagnostic certainty. Whether this increased utilization results in improved patient outcomes is uncertain and deserves further study.