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We’re constantly on the look out for ways to save money in the US health care system. Targeting waste is our best bet to do so. A new study in JAMA Pediatrics points out a contender – low-value diagnostic imaging in the emergency department.

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We're constantly on the look out for ways to save money in the United States healthcare system. Targeting waste is our best bet to do so. A new study in JAMA Pediatrics points out a contender: low-value diagnostic imaging in the emergency department. This is Healthcare Triage News.


To the research! Low-Value Diagnostic Imaging Use in the Pediatric Emergency Department in the United States and Canada.

Researchers used data from 2006 to 2016 to examine patients who visited one of four pediatric emergency rooms in Ontario, and one of 27 children's hospital emergency rooms in the United States. For all patients seen, they abstracted information on their demographics, when and where they were seen, and how ill they were. They also looked at whether imaging was done, specifically chest x-rays, abdominal x-rays, abdominal ultrasounds, abdominal CT, head CT, and head MRIs.

To get at "low value imaging," they set some specific requirements that were agreed upon by 11 study authors. These included chest x-rays for asthma, chest - for bronchiolitis, abdominal x-rays, ultrasounds, or CT for abdominal pain, abdominal x-rays, ultrasound, or CT for constipation, head CT or MRI for concussion, head CT for simple febrile seizure, head CT for complex febrile seizures, head CT or MRI for pretty much any seizure, and head CT or MRI for headache. These are all pretty widely accepted as low-value. Many are featured in choosing wisely, which we've discussed before.

Just to be safe, they also looked at whether patients who were sent home with these diagnoses, but who didn't get that low-value imaging, had higher rates of admission at 3 or 7 days after the emergency department visit. If they did, it would suggest that not getting the scans might have led to the doctors missing something.

And what did they find? There were about 1.8 million visits in Ontario and 21.8 million in the United States to look at, and less imaging occurs in Canada. Head CT rates were about 1.3% of visits in Canada versus 2.5% in the US. And, I could just keep rattling off numbers, but here's a chart that shows you that pretty much everything was done way more in the United States.

Low-value imaging was also lower in Canada for many of the indications we mentioned before, including abdominal x-rays for constipation and abdominal pain and head CTs for concussion. Abdominal CTs for constipation and abdominal pain were approximately ten times more common in the United States, although low overall.

The three day and seven day rates of adverse outcomes were the same in both countries, for the most part. And, this was a big study. There doesn't seem to be a downside to not getting these low-value imaging scans.

Not all of these scans are harmless, either. Xrays and, especially, CTs have a lot of radiation, and we're talking kids here. It can have long term implications.

We're getting much more of this imaging in the United States than in Canada. This is a real opportunity, not only to save money, but also to improve quality. We should think about it.


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