Published February 17, 2012
Contrary to previous research showing the number of CT scans done on children is rising, a new study finds use of the technology has leveled off and might even be declining -- at least in Georgia ERs.
The radiation from CT scans carries a small risk of cancer, which has fueled concerns about overuse, particularly in kids.
"If we're lucky, this publication does reflect an increased awareness," said Dr. Josh Broder, a professor at Duke University Medical Center, who was not involved in this study.
But, he told Reuters Health, "The thing that is striking to me is that (the researchers) are reaching a very different conclusion than almost anybody."
CT, or computed tomography, scans are high-dose x-ray images used to detect injuries or abnormalities that normal x-rays have trouble spotting.
Earlier work by Broder and others has found the scans have become more and more popular since the late 1990s.
The current study looked at a more recent time period than previous research. Researchers collected nearly a million medical records from two pediatric emergency departments between 2003 and 2010.
They found about five out of every 100 kids who came into the ER received a CT scan, most of them of the head. And that number held steady over the years.
It's unclear why CT use at these facilities seemed to buck the trend.
Dr. Margaret Menoch, the lead author of the study and a researcher at Emory University in Atlanta, said one reason might be that "both physicians and parents are more cognizant of radiation risks from CTs."
That might have made people more willing to wait and see instead of ordering a scan right away, Menoch and her colleagues write in the journal Pediatrics.
Also, a greater availability of ultrasound and MRI machines and expertise could have led patients away from CT scans.
Broder pointed out that the new numbers seem high to begin with, and perhaps that could explain why there wasn't an increase.
For instance, 29 percent of kids who came to the emergency department with a possible head injury got a CT scan.
"That's a really high rate of head CT," Broder told Reuters Health. "So maybe they're already maxed out."
Dr. David Larson, of Cincinnati Children's Hospital Medical Center, agreed. He said the national estimates of CT use in 2003 were lower than at the emergency rooms in Menoch's study.
"Yes, the national rate has increased, but (these emergency departments) already were at a higher utilization rate," he told Reuters Health.
Menoch and her team did find a drop in CT use in some cases.
For instance, about 30 percent of kids who came to the ER with possible head injuries received a CT scan in 2003, compared to about 25 percent in 2010.
Menoch told Reuters Health that it's encouraging to see a decrease in exposure to something that carries a risk of harm. But no one is certain what the appropriate level of CT scan use should be, she said.
The researchers point out that the scans are a "vital tool for rapid patient evaluation and management."