Imaging modalities that expose children to ionizing radiation are used more frequently at non-children's hospitals than at children's hospitals, Harvey L. Neiman Health Policy Institute (HPI) researchers have reported.
The study underscores the need for "ongoing evaluation of pediatric imaging practices across all hospital types, particularly those that care for large volumes of children but may lack pediatric‑specific imaging infrastructure," according to an HPI statement. The results were published January 20 in the Journal of the American College of Radiology.
"The data show clear, measurable variation in imaging practices between children's and non‑children’s hospitals," lead author and HPI principal economics and health services researcher Casey Pelzl said in the statement. "Even after accounting for factors like patient complexity and chief complaint, CT and radiography were used more often at non‑children's hospitals."
Limiting children's radiation exposure is particularly important because they are at higher risk than adults of developing cancer after being exposed, the researchers noted. The HPI team conducted a study in collaboration with the American College of Radiology's (ACR) Pediatric Imaging Research (PIR) committee with the intention of comparing imaging use in pediatric outpatients at children's hospitals versus non-children's hospitals in order to identify radiation exposure differences across various modalities.
Pelzl and colleagues used data from the Centers for Medicare and Medicaid Services (CMS) Medicaid Research Identifiable Files to identify outpatient claims of pediatric patients (ages 0 to 17 years) from hospital outpatient facilities and emergency departments between 2018 and 2019. The primary outcome of the research was to identify the use of CT, MRI, ultrasound, or x-ray for each visit and to compare the incidence of these exams between children's hospitals and non-children's hospitals. The team also evaluated results by age group, pediatric comorbidity index, and place of service.
The study included 5.4 million claims. More than half of visits (53%) were to children's hospitals, and 15% were to emergency departments. The group reported that children's hospital encounters were more likely than non-children's hospital encounters to be the following:
- With patients between the ages of 0 and 5 versus those over 5 years old (41.2% vs. 38.7%; p < 0.01);
- With patients with a pediatric comorbidity index greater than 2 (32.3% vs. 22.9%; p < 0.01);
- With patients seen at hospital outpatient facilities (87.8% vs. 81.9%; p < 0.01).
The team also found the following:
Comparison of use of radiation-exposing imaging modalities at children's hospitals and non-children's hospitals | |||
Modality | Non-children's hospitals | Children's hospitals | p-value |
| X-ray | 11.8% | 7.5% | <0.01 |
| CT | 1% | 0.5% | <0.01 |
| Ultrasound | 1.7% | 2.5% | <0.01 |
| MRI | 0.5% | 0.9% | <0.01 |
The findings show "that non-children’s hospitals rely more heavily on CT and radiography, which use ionizing radiation that can cause DNA damage, while children's hospitals make greater use of safer imaging, including MRI and ultrasound," the HPI noted.
The differences in imaging utilization between children's and non-children's hospitals "raise important considerations for pediatric imaging safety and adherence to Image Gently's mission to limit radiation exposure for pediatric patients," according to the HPI.
"Children are not just small adults, and the imaging used in their diagnoses should reflect children’s higher sensitivity to ionizing radiation,” said coauthor Sherwin Chan, MD, cochair of the ACR's PIR committee. "Forty-seven percent of the 5.4 million encounters in our study occurred in non-children's hospitals, highlighting the need for broader adoption of pediatric‑appropriate imaging protocols in these settings."
Click here to access the full study.
