Ontario paediatric emergency departments order fewer low-value imaging tests than US counterparts

Lower use of imaging tests in Ontario paediatric emergency departments (EDs) was not associated with higher rates of poor outcomes, suggesting that use may be safely reduced in the United States, according to a new study by researchers at ICES and The Hospital for Sick Children (SickKids).

Choosing Wisely, a campaign targeting overuse of care that provides little benefit, was launched in 2012. Diagnostic imaging (e.g. MRIs, ultrasounds and x-rays) overuse in children seen in EDs accounts for three of the first five of the American Academy of Pediatrics Choosing Wisely recommendations and six of the 10 Choosing Wisely recommendations for emergency medicine in Canada.

The study, published June 3rd in JAMA Pediatrics, compared the use of low-value diagnostic imaging rates from four paediatric EDs in Ontario to 26 in the United States from 2006 to 2016. The researchers looked at data for children 18 years and younger who were discharged from the ED during the study period with a diagnosis for which routine use of diagnostic imaging may not be necessary, like asthma or constipation.

“This finding was most pronounced for diagnostic imaging associated with radiation exposure such as plain radiographs and CT scans for concussion and gastrointestinal complaints like constipation and abdominal pain. Although not commonly used in either country, abdominal CT scan use was approximately 10-fold lower in Canada than the US for both constipation and abdominal pain,” says Dr. Eyal Cohen, lead author of the study, co-founder of the complex care program and interim head of the Child Health Evaluative Sciences program at SickKids, and adjunct scientist at ICES.

The researchers found lower imaging rates in Canada were not associated with future hospitalization, intensive care unit admissions, surgery, or death.

Minimizing care that provides little benefit to patients has become an important focus to decrease health care costs and improve the quality of care delivery. Diagnostic imaging in children is a common focus for campaigns designed to reduce overuse both in Canada and the US.

“There may be opportunities to safely reduce low-value imaging in pediatric emergency departments in the United States to better align resource use with high-quality care delivery,” adds Cohen.

Author block: Eyal Cohen, Jonathan Rodean, Christina Diong, Matt Hall, Stephen B. Freedman, Paul L. Aronson, Harold K. Simon, Jennifer R. Marin, Margaret Samuels-Kalow, Elizabeth R. Alpern, Rustin B. Morse, Samir S. Shah, Alon Peltz and Mark I. Neuman.

The study “Low-value diagnostic imaging use in the pediatric emergency department in the United States and Canada,” is published in the June 3 issue of JAMA Pediatrics.