title: Nationwide emergency department imaging practices for pediatric urolithiasis: room for improvement.
abstract: OBJECTIVE
  Children are particularly vulnerable to the harmful effects of medical radiation, and children with urolithiasis comprise a group that may undergo repeated radiation intensive imaging tests. We sought to characterize imaging practices for children presenting to the emergency department with suspected urolithiasis and to determine factors associated with the choice of imaging study.
  
  
  METHODS
  Using the 2006 to 2010 Nationwide Emergency Department Sample, we conducted a retrospective cohort study of patients younger than 18 years presenting with suspected urolithiasis. We determined imaging practices for visits to emergency departments where billing codes for computerized tomography and ultrasound were reliably reported. Logistic regression was used to delineate patient and hospital level factors associated with the use of computerized tomography vs ultrasound.
  
  
  RESULTS
  We identified 18,096 pediatric visits for suspected urolithiasis in the 1,191 Nationwide Emergency Department Sample emergency departments with reliable imaging codes. A total of 11,215 patients underwent computerized tomography alone, ultrasound alone or both. Of the patients 9,773 (87%) underwent computerized tomography alone. Computerized tomography use peaked in 2007 and declined thereafter. On multivariate analysis several factors were associated with the use of computerized tomography alone, including smaller proportion of pediatric patients treated at the emergency department, older age, location in the Midwest or South, evaluation at a nonteaching hospital and visit on a weekend.
  
  
  CONCLUSIONS
  Computerized tomography use is highly prevalent for children presenting with suspected urolithiasis. The lowest computerized tomography use is in emergency departments that care for more children. Ultrasound is used infrequently regardless of site. Awareness regarding risks of computerized tomography and consideration of alternatives including ultrasound are warranted in caring for these patients.
authors: Department of Urology, Boston Children's Hospital, Boston, Massachusetts. Electronic address: emilie.johnson@childrens.harvard.edu.
authors: Emilie K
authors: EK
authors: Johnson
authors: Center for Patient Safety and Quality Research, Boston Children's Hospital, Boston, Massachusetts.
authors: Dionne A
authors: DA
authors: Graham
authors: Department of Radiology, Boston Children's Hospital, Boston, Massachusetts.
authors: Jeanne S
authors: JS
authors: Chow
authors: Department of Urology, Boston Children's Hospital, Boston, Massachusetts.
authors: Caleb P
authors: CP
authors: Nelson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D011829:Radiation Dosage; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000592:standards / Q000706:statistics & numerical data*; D014463:Ultrasonography; D014481:United States; D052878:Urolithiasis / Q000000981:diagnostic imaging*
keywords: emergency treatment; pediatrics; tomography; ultrasonography; urolithiasis; x-ray computed