title: Variation in Computed Tomography Imaging for Pediatric Injury-Related Emergency Visits.
abstract: OBJECTIVE
  To assess variation in the use of computed tomography (CT) for pediatric injury-related emergency department (ED) visits.
  
  
  METHODS
  This was a retrospective cohort study of visits to 14 network-affiliated EDs from November 2010 through February 2013. Visits were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Primary outcome was CT use. We used descriptive statistics and performed multivariable logistic regression to evaluate the association of patient and ED covariates on any and body region-specific CT use.
  
  
  RESULTS
  Of the 80 868 injury-related visits, 11.4% included CT, and 28.4% of those involved more than 1 CT. Across EDs, CT use ranged from 7.6% to 25.5% of visits and did not correlate with institutional Injury Severity Score (P = .33) or admission/transfer rates (P = .07). In multivariable analysis of nonpediatric EDs, trauma centers and nonacademic EDs were associated with CT use. Higher pediatric volume was associated with any CT use; however, there was an inverse relationship between volume and nonhead CT use. When the pediatric ED was included in multivariable modeling, the effect of level 1-3 trauma center designation remained, and the pediatric level 1 trauma center was less likely to use most body region-specific CTs.
  
  
  CONCLUSIONS
  There is wide variation in CT imaging for pediatric injury-related visits not attributable solely to case mix. Future work to optimize CT utilization should focus on additional factors contributing to imaging practices and interventions.
authors.affiliation: Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: Jennifer.marin@chp.edu.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Marin
authors.affiliation: Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Winger
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA.
authors.forename: Rebekah C
authors.initials: RC
authors.lastname: Mannix
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010343:Patient Admission / Q000706:statistics & numerical data; D010372:Pediatrics; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000000981:diagnostic imaging