Incidence and pathology of repeat computed tomography of the abdomen and pelvis in a pediatric emergency department population

摘要

OBJECTIVES: Computed tomographic (CT) scanning is increasingly prevalent in emergency departments (EDs). It is a moderate-to high-radiation diagnostic technique that exposes more than 1 million children per year to unnecessary radiation. Repeat CT of the abdomen and pelvis (CTAP) among pediatric patients who return to the ED within 1 year may be an example of unnecessary pediatric radiation exposure. The objectives of this study were to identify the incidence of pediatric patients who undergo more than 1 CTAP within 1 year and to detect the incidence of significant pathology on these repeat scans. METHODS: This was a retrospective review of subjects younger than 18 years with an initial CTAP as an ED patient, inpatient, or outpatient and a second CTAP within 12 months and during an ED visit. RESULTS: During the observation period, 172 pediatric ED admissions had at least 1 repeat admission involving an abdominal CT scan. Thirty-seven of the CT scans (19.3%) were positive. Sixty percent of the positive cases (n = 22) were attributable to the 3 most prevalent diagnoses: appendicitis in 8 cases (21.6%), kidney stone in 8 cases (21.6%), and colitis in 6 cases (16.2%). Approximately, one third of repeat CT scans occurred within the first month of the initial CT scan, and two thirds occurred within 6 months of the initial CT scan. CONCLUSIONS: A substantial percentage of pediatric patients undergo more than 1 CTAP within a 1-year time frame. Among these patients, a large portion were diagnosed significant pathology.