PDF(Pubmed)
Abstract：
UNASSIGNED: To analyse changes in the use of paediatric (≤16 years) CT over the past decade and to evaluate the appropriateness of CT examinations at a tertiary teaching hospital.
UNASSIGNED: Data from 290 paediatric CTs were prospectively collected in 2022 and compared with data from 2017 (358 cases) and 2012 (538 cases). The justification of CTs was evaluated with regard to medical imaging referral guidelines and appropriateness rates were calculated.
UNASSIGNED: Paediatric CTs decreased 39.4% over the 10 years, contrasting with a 27.6% increase in overall CTs. Paediatric CTs as the share of overall CTs dropped from 2.5% in 2012 to 1.1% in 2022 (P < .0001), with a concurrent rise in paediatric MRIs (P < .0001). Notable reductions in CT use occurred for head trauma (P = .0003), chronic headache (P < .0001), epilepsy (P = .037), hydrocephalus (P = .0078), chest tumour (P = .0005), and whole-body tumour (P = .0041). The overall appropriateness of CTs improved from 73.1% in 2017 to 79.0% in 2022 (P = .0049). In 15.4% of the cases, no radiological examination was deemed necessary, and in 8.7% of the cases, another modality was more appropriate. Appropriateness rates were the highest for the head and neck angiography (100%) and the chest (96%) and the lowest for the neck (66%) and the head (67%).
UNASSIGNED: Justification of CT scans can be improved by regular educational interventions, increasing MRI accessibility, and evaluating the appropriateness of the requested CT before the examination. Interventions for a more effective implementation of referral guidelines are needed.
UNASSIGNED: The focus for improvement should be CTs for head and cervical spine trauma, accounting for the majority of inappropriate requests in the paediatric population.
UNASSIGNED: Data from 290 paediatric CTs were prospectively collected in 2022 and compared with data from 2017 (358 cases) and 2012 (538 cases). The justification of CTs was evaluated with regard to medical imaging referral guidelines and appropriateness rates were calculated.
UNASSIGNED: Paediatric CTs decreased 39.4% over the 10 years, contrasting with a 27.6% increase in overall CTs. Paediatric CTs as the share of overall CTs dropped from 2.5% in 2012 to 1.1% in 2022 (P < .0001), with a concurrent rise in paediatric MRIs (P < .0001). Notable reductions in CT use occurred for head trauma (P = .0003), chronic headache (P < .0001), epilepsy (P = .037), hydrocephalus (P = .0078), chest tumour (P = .0005), and whole-body tumour (P = .0041). The overall appropriateness of CTs improved from 73.1% in 2017 to 79.0% in 2022 (P = .0049). In 15.4% of the cases, no radiological examination was deemed necessary, and in 8.7% of the cases, another modality was more appropriate. Appropriateness rates were the highest for the head and neck angiography (100%) and the chest (96%) and the lowest for the neck (66%) and the head (67%).
UNASSIGNED: Justification of CT scans can be improved by regular educational interventions, increasing MRI accessibility, and evaluating the appropriateness of the requested CT before the examination. Interventions for a more effective implementation of referral guidelines are needed.
UNASSIGNED: The focus for improvement should be CTs for head and cervical spine trauma, accounting for the majority of inappropriate requests in the paediatric population.
摘要：
■分析过去十年中儿科（≤16年）CT使用的变化，并评估三级教学医院CT检查的适当性。
■2022年前瞻性收集了290例儿科CT的数据，并与2017年（358例）和2012年（538例）的数据进行了比较。根据医学影像学转诊指南评估了CT的合理性，并计算了适当率。
■儿科CT在过去10年中下降了39.4%，相比之下，总CT增加了27.6%。儿科CT占整体CT的比例从2012年的2.5%下降到2022年的1.1%（P<0.0001），同时儿科MRI升高（P<0.0001）。头部创伤CT使用显著减少（P=.0003），慢性头痛（P<0.0001），癫痫（P=0.037），脑积水(P=.0078),胸部肿瘤（P=.0005），和全身肿瘤（P=.0041）。CT的总体适宜性从2017年的73.1%提高到2022年的79.0%（P=.0049）。在15.4%的案例中，认为没有必要进行放射学检查，在8.7%的病例中，另一种方式更合适。头颈部血管造影（100％）和胸部（96％）的适合率最高，颈部（66％）和头部（67％）的适合率最低。
■通过定期教育干预可以改善CT扫描的合理性，增加MRI的可及性，并在检查前评估所需CT的适当性。需要采取干预措施，以更有效地实施转诊指南。
■改善的重点应该是头部和颈椎外伤的CT，占儿科人群中大多数不适当的请求。
■2022年前瞻性收集了290例儿科CT的数据，并与2017年（358例）和2012年（538例）的数据进行了比较。根据医学影像学转诊指南评估了CT的合理性，并计算了适当率。
■儿科CT在过去10年中下降了39.4%，相比之下，总CT增加了27.6%。儿科CT占整体CT的比例从2012年的2.5%下降到2022年的1.1%（P<0.0001），同时儿科MRI升高（P<0.0001）。头部创伤CT使用显著减少（P=.0003），慢性头痛（P<0.0001），癫痫（P=0.037），脑积水(P=.0078),胸部肿瘤（P=.0005），和全身肿瘤（P=.0041）。CT的总体适宜性从2017年的73.1%提高到2022年的79.0%（P=.0049）。在15.4%的案例中，认为没有必要进行放射学检查，在8.7%的病例中，另一种方式更合适。头颈部血管造影（100％）和胸部（96％）的适合率最高，颈部（66％）和头部（67％）的适合率最低。
■通过定期教育干预可以改善CT扫描的合理性，增加MRI的可及性，并在检查前评估所需CT的适当性。需要采取干预措施，以更有效地实施转诊指南。
■改善的重点应该是头部和颈椎外伤的CT，占儿科人群中大多数不适当的请求。
