Emergency Department Use of Computed Tomography for Children with Ventricular Shunts

摘要: Objectives To quantify rates and variation in emergency department (ED) cranial computed tomography (CT) utilization children with ventricular shunts, estimate radiation exposure, evaluate the association between CT shunt revision. Study design Retrospective longitudinal cohort study of ED visits from 2003-2013 0-18 years old initial placement 2003. Data were examined 31 hospitals Pediatric Health Information System. Main outcomes performed during an visit, estimated cumulative effective dose, revision within 7 days. Multivariable regression modeled relationship patient- hospital-level covariates utilization. Results The 1319 placed 2003 experienced 6636 subsequent decade. A was obtained 49.4% all visits; 19.9% associated a Approximately 6% patients received ≥10 CTs, accounting for 37.2% CT. mean number CTs per patient varied nearly 20-fold across hospitals; individual hospital accounted most median (IQR) dose 7.2 millisieverts (3.6-14.0) overall, 33.4 (27.2-43.8) among receiving CTs. Conclusions scan half shunt, wide variability by hospitals. Strategies are needed to identify at risk malfunction reduce exposure ED.