Study finds many pediatric emergency CT requests may be inappropriate

More than half of completed pediatric emergency CT requests for neurological indications may not align with American College of Radiology appropriateness criteria, according to research published in Emergency Radiology.

Researchers reviewed 462 CT requests submitted in the emergency department of an Italian pediatric hospital. The study assessed requests against the pediatric panel of the ACR Appropriateness Criteria.

Complete CT requests were available in 348 cases. Of those, 54% were rated “usually not appropriate,” 29.9% were rated “may be appropriate,” and 16.1% were rated “usually appropriate.”

Nearly 25% of the 462 requests had incomplete or ambiguous clinical information. More than 43% of headache-related cases lacked enough clinical detail, the authors noted.

Inappropriate CT requests were most common in seizure cases, at 87.1%. They were also reported in 57.7% of headache cases and 41.7% of head trauma cases.

The authors cautioned that pediatric CT overuse can be especially consequential because children have higher sensitivity to radiation and longer expected lifespans after exposure. They described diagnostic imaging appropriateness as a “key performance indicator” for patient safety.

Fear of missing critical findings may partly explain the high rate of inappropriate exams, according to the study authors. They said defensive medicine remains a common challenge, particularly in emergency department settings.

Suggested interventions included better communication between emergency clinicians and radiology teams, along with more complete clinical information in imaging requests.

The authors also acknowledged limitations, including that 1 trainee operator evaluated requests against the ACR criteria and that the analysis did not review CT exams performed after the requests were submitted.