Appropriateness of Radiology Procedures Performed in Children With Gastrointestinal Symptoms and Conditions

• Published in: Clinical gastroenterology and hepatology Vol. 12; no. 6; pp. 970 - 977
• Main Authors: Tompane, Trevor, Leong, Curtis W, Bush, Ruth, Chuang, Nathaniel A, Dansky, Tanya, Huang, Jeannie S
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2014
• Subjects: Adolescent; Appropriateness; Child; Child, Preschool; Cohort Studies; Diagnostic Imaging; Diagnostic Imaging - methods; Diagnostic Imaging - utilization; Female; Gastroenterology and Hepatology; Gastrointestinal Diseases - diagnosis; Humans; Infant; Infant, Newborn; Male; Pediatrics; Radiation; Radiology - methods; Retrospective Studies; United States; United States; computed tomography; Pediatrics; OR; Radiation; DIP; odds ratio; diagnostic imaging procedure; Diagnostic Imaging; CT; ICD-9; Independent Physicians Association; IPA; Appropriateness; International Classification of Diseases, 9th revision
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/j.cgh.2013.08.044

Background & Aims Exposure to ionizing radiation from diagnostic imaging procedures (DIPs) has been associated with an increased risk of cancer in children. In particular, gastrointestinal imaging has been identified as a significant factor that contributes to exposure of children to radiation during diagnostic procedures. We performed a longitudinal assessment of gastrointestinal-associated DIPs to identify practices that might be targeted to reduce exposure of pediatric patients to radiation. Methods DIP insurance claims from 2001 through 2009 were obtained from an Independent Physicians Association in a large US metropolitan area. We retrieved and analyzed Current Procedural Terminology codes, associated International Classification of Diseases, 9th Revision, codes specific for gastrointestinal symptoms and conditions, and patient demographics associated with DIPs from insurance claims data. Results Overall, 11,473 DIPs were performed on 6550 children with gastrointestinal symptoms; 1 in 30 patients received a DIP for a gastrointestinal complaint. Over the study period, the proportion of higher-radiation DIPs (computed tomography, fluoroscopy, and angiography) increased. Higher-radiation DIPs for gastrointestinal symptoms were performed more frequently in older children and in boys in the emergency department and in inpatient settings for diagnoses of abdominal pain, appendicitis, and noninfectious gastroenteritis. Conclusions Higher-radiation diagnostic imaging accounts for an increasing proportion of imaging procedures among children with gastrointestinal symptoms, even though these often are not recommended for evaluation of gastrointestinal disorders. Clinicians should be aware of these findings when ordering DIPs for gastrointestinal complaints, and clinical practice guidelines should be created to reduce diagnostic imaging–related radiation exposure in children.