CT Scans on Children in ER Rooms Increasing

A study conducted between 1995 and 2008 showed a five-fold increase in the number of children who received CT scans during ER visits.

that a study conducted from 1995 to 2008 showed a five-fold increase in the number of children who received CT scans during ER visits, according to a study published in Radiology on Tuesday (April 5th 2011).

The study was headed by Dr. David Larson at Cincinnati Children's Hospital Medical Center and found that since the beginning of the study in 1995, the number of children receiving CT scans during ER visits has risen from roughly 330,000 to 1.65 million in 2008, a percentage increase from nearly 1% to 6%. The ER visits themselves did not increase.

The largest issue with these results is the rising concern from parents and physicians that the exposure of children to increased radiation doses may result in potential risks for cancer down the road.

While increases were noted at both children’s hospitals and general hospitals alike, the increase at general hospitals is what elicits the most alarm, since the doses of radiation may have been larger or “adult-sized” in these ER rooms.

The study lacked definitive dosage information, as this data was not included in the annual government surveys on ER visits in non-federal hospitals across the nation, which the study authors used to determine statistics; they concentrated on the population below the age of eighteen that received CT scans.

General hospitals may be less likely than pediatric facilities to use special CT protocols with kids to limit their radiation exposure, according to the study authors.

According to the American College of Radiology, the same amount of radiation a singular CT scan of the abdomen and pelvis produces is equal to five years of exposure to naturally occurring radiation.

Radiation has the potential to damage rapidly dividing cells, and children have more of those than adults.

The researchers said a theory as to why this increase has occurred is because imaging improved over the years the study was performed; scanners became more visually and time efficient, and in the setting of a booked ER room, fast answers are a plus.

This is not the only possible answer, however; the pressure of getting sued for not ordering certain tests and failing to correctly diagnosis a patient can be a motivating factor. When the patient is a child, this pressure can feel doubled.

"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," said Larson.

In the study, CT scans were used on children mostly for head injuries, headaches, or abdominal pain—all too common injuries and ailments in active, growing children.

Founder of the Image Gently Campaign and pediatric radiologist, Dr. Marta Hernanz-Schulman, reported being none too surprised at the study’s results. She said the study trends "are very believable" and demonstrate the necessity for conservation when deciding whether a CT scan is required for a child.

Image Gently began in 2008 and was formed by Hernanz-Schulman along with a team of doctors, all seeking to raise awareness of the risk of medically over-radiating small, growing bodies.

On a positive note, Larson reported that since the end of the study, there are possible signs of a decrease in CT scans on children.

Many institutions, such as Chicago's Children's Memorial Hospital, have adopted the practice of using ultrasound imaging to diagnose ailments in children, such as appendicitis; while ultrasound imaging isn’t as detailed as CT images, the practice may still assist in restricting radiation exposure.

Another practice is the adjustment of the CT scan radiation dosage to the size and weight of the child, such as performed at Carle Foundation Hospital in Urbana, Ill., where roughly 20% of the ER patients are children. Dr. Mike Swindle, emergency department chief of the hospital, said "We've all become a bit more conservative with ordering" CT scans.

There is also a positive trend of parents becoming increasingly aware of the risks associated with CT scans and have begun to question doctors about the risks of such a procedure before requesting it.