2024, Vol. 7, Issue 2, Part A

Objective: To determine the frequency and appropriateness of common CT examinations among children and young adults.

Design: Cross-sectional retrospective review.

Study setting: Six hospital-based CT units including public, private not-for-profit (PNFP), private for -profit, tertiary hospitals and university teaching hospitals.

Data source: Paper-based requests for patients aged 35 years and below who had CT examinations performed between 1^st July and 31^st December 2018 were reviewed independently for appropriateness using an online European Society of Radiology guideline (ESR iGuide). https://prod.esriguide.org. Scores 7-9 were classified as appropriate, while 1-6 as inappropriate.

Outcome measure: The primary outcome measure was the appropriateness rate (AR) for a group.

Results: Of 909 CT examinations 57% were from PNFP hospitals, 29.5% (268/909) for children, 82% 82% (746/909) for head and 73% (666/909) for non-contrasted examinations.

Overall inappropriate CT examinations were 38% (347/909), significantly from PNFP (230/347, 66.2%, p<0.001). Additionally, children were 28% (36% 125/347, vs 64%, 222/347, p<0.001) less likely to have an inappropriate CT scan than adults. Head CT examinations were more likely to be inappropriate (239/316, 75.6%), (p< 0.001), compared to the rest of the anatomical regions. A CT examination performed for non-trauma related indications was 1.3 times more likely to be inappropriate (55.7%, 136/244 vs 44.3%, 108/244, p<0.001) than those related to trauma, while non-contrasted CT examinations were more likely to be inappropriate (190/347, 54.7%, p< 0.001) compared to contrasted examinations (88/347, 25.3%).

Conclusions: The study registered high rates of inappropriate CT examination that significantly varied with age, anatomical region, indication, and use of contrast media.

Future research to identify factors influencing imaging referrers’ decision-making when ordering CT examination is recommended. The findings may guide developing strategies and tailored evidence-based interventions to effectively utilize imaging resources and improve healthcare outcomes.