Gupta et al.11. Gupta M, Mower WR, Rodriguez RM, Hendey GW. Validation of the pediatric NEXUS II head computed tomography decision instrument for selective imaging of pediatric patients with blunt head trauma. Acad Emerg Med. 2018;25:729-37. https://doi.org/10.1111/acem.13431 https://doi.org/https://doi.org/10.1111/...
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The NEXUS instrument, for head CT, enabled the identification of pediatric patients with blunt trauma that really needed a CT, which can significantly reduce the use of this imaging examination in children. |
Ohana et al.22. Ohana O, Soffer S, Zimlichman E, Klang E. Overuse of CT and MRI in paediatric emergency departments. Br J Radiol. 2018;91:20170434. https://doi.org/10.1259/bjr.20170434 https://doi.org/https://doi.org/10.1259/...
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Review |
Even though a reduction in the use of CT in children has been registered, the overuse rates are still very high. Therefore, it is necessary to implement protocols, such as PECARN and Alvarado, which regulate the requirements of imaging examinations in pediatric UE. |
Rao et al.77. Rao S, Rao S, Rincon S, Caruso P, Ptak T, Raja AS, et al. Assessment of pediatric neurotrauma imaging appropriateness at a level I pediatric trauma center. J Am Coll Radiol. 2016;13:788-93. https://doi.org/10.1016/j.jacr.2016.02.022 https://doi.org/https://doi.org/10.1016/...
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Retrospective study
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(n=207)
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The use of the ACR Appropriateness Criteria guideline allowed pediatric patients submitted to neuroimage due to TBI to solve their symptoms with conservative treatment, thus reducing the number of unnecessary imaging examinations in children. |
Reiter et al.88. Reiter J, Breuer A, Breuer O, Hashavya S, Rekhtman D, Kerem E, et al. A quality improvement intervention to reduce emergency department radiography for bronchiolitis. Respir Med. 2018;137:1-5. https://doi.org/10.1016/j.rmed.2018.02.014 https://doi.org/https://doi.org/10.1016/...
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The intervention that reinforced the AAP guidelines in the pediatric emergency department led to the reduction of unnecessary imaging examinations, promoting higher cost-effectiveness and saving resources and time for the UE. |
Chamberlain et al.99. Chamberlain JM, Teach SJ, Hayes KL, Badolato G, Goyal MK. Practice pattern variation in the care of children with acute asthma. Acad Emerg Med. 2016;23:166-70. https://doi.org/10.1111/acem.12857 https://doi.org/https://doi.org/10.1111/...
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Pediatric UEs tend to present lower rates of X-ray requests compared to general UEs when treating children with acute exacerbation of asthma. |
Kwon et al.1010. Kwon H, Jung JY. Effectiveness of a radiation reduction campaign targeting children with gastrointestinal symptoms in a pediatric emergency department. Medicine (Baltimore). 2017;96:e5907. https://doi.org/10.1097/md.0000000000005907 https://doi.org/https://doi.org/10.1097/...
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Obsevational study
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(n=14,244)
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There was a reduction in the total level of APF X-ray in children with gastrointestinal symptoms, after the adoption of a campaign with orientations about the examination. |
Rawlins et al.1111. Rawlins KW, Allen DZ, Onwuka AJ, Elmaraghy CA. Computed tomography use patterns for pediatric patients with peritonsillar abscess. Int J Pediatr Otorhinolaryngol. 2019;123:22-5. https://doi.org/10.1016/j.ijporl.2019.04.027 https://doi.org/https://doi.org/10.1016/...
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When requesting that the clinical staff of the UE consulted the Otorhinolaryngology team before requesting an imaging examination for children with unspecific physical examination, it was possible to observe reduction in the number of patients submitted to CT and the increase in the frequency of surgical interventions for the treatment of PTA. |
Gökharman et al.1212. Gökharman FD, Aydın S, Fatihoğlu E, Koşar PN. Pediatric Emergency Care Applied Research Network head injury prediction rules: on the basis of cost and effectiveness. Turk J Med Sci. 2017;47:1770-7. https://doi.org/10.3906/sag-1703-206 https://doi.org/https://doi.org/10.3906/...
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Retrospective study
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(n=1,041)
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With the PECARN instrument, it was possible to identify higher rates of appropriate CTs in pediatric patients with TBI, once this instrument has proven to enable the identification of the presence and severity of the pathology. |
Broers et al.1313. Broers MC, Niermeijer JF, Kotsopoulos IA, Lingsma HF, Bruinenberg JF, Catsman-Berrevoets CE. Evaluation of management and guideline adherence in children with mild traumatic brain injury. Brain Inj. 2018;32:1028-39. https://doi.org/10.1080/02699052.2018.1469047 https://doi.org/https://doi.org/10.1080/...
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The guideline from the Netherlands Society of Neurology (2010) is the orientation for the clinical management of pediatric patients with non-severe TBI in the UEs of hospitals in the Netherlands. However, there was a disagreement between this recommendation and clinical practice when observing the preference for hospitalization than the CT request. |
Cohen et al.1414. Cohen E, Rodean J, Diong C, Hall M, Freedman SB, Aronson PL, et al. Low-value diagnostic imaging use in the pediatric emergency department in the United States and Canada. JAMA Pediatr. 2019;173:e191439. https://doi.org/10.1001/jamapediatrics.2019.1439 https://doi.org/https://doi.org/10.1001/...
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Retrospective study
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(n=23,591,084)
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The rates of use of imaging examinations in the pediatric UEs were lower in Canada than in the USA. This lower rate is not associated to worse prognosis, suggesting that the USA can better administrate the use of resources and reduce, with safety, the performance of imaging examinations. |