A study in Pediatrics describes a dramatic increase in the use of computed tomography (CT or CAT) scans in children who present to emergency departments with abdominal pain. In 1998, less than 1% of these children received a CT scan. Just ten years later, in 2008, more than 15% of these kids received the same diagnostic test.
The main use of CT scans for abdominal pain in an emergency room setting is to diagnose the presence or absence of acute appendicitis. The advantages for the child are that CT scans are readily available to most emergency departments and scanning is fast and accurate. The biggest advantage is if the scan does not demonstrate appendicitis, then surgery is not necessary. The disadvantages of doing so many CT scans are the child’s exposure to radiation (considerably more than a routine chest x-ray) as well as the cost (several hundred dollars at least) to the family.
Some might think that emergency room doctors order these tests to get patients out of the emergency room fast (either to surgery or to home). Others might suggest that there is a huge risk of a lawsuit if the emergency room physician misses an appendicitis. Both are true. However, when it comes to children, most emergency room doctors really do want what is best for the child. They don’t want to see children in pain. If there is a way to diagnose abdominal pain faster and more accurately than with other methods, of course they would choose that. Yes, it covers their butts, but it also gets these kids to surgery faster if they need it or to pain relief and home faster if they don’t.
The problem is we still really don’t know the threshold of how much radiation is too much in children. You might think that any radiation is bad, but we just don’t know that for sure.
The use of CT scans when kids suffer a concussion has also been on the rise and has caused controversy. Most pediatricians and pediatric emergency physicians understand the need to limit all tests unless truly necessary.
Frederik Joelving summarizes the problem here.