MedicalResearch.com Interview with:
Eyal Cohen, MD, M.Sc, FRCP(C)
University of Toronto
Co-Founder, Complex Care Program
The Hospital for Sick Children
MedicalResearch.com: What is the background for this study?
Response: Minimizing care that provides little benefit to patients has become an important focus to decrease health care costs and improve the quality of care delivery. Diagnostic imaging in children is a common focus for campaigns designed to reduce overuse both in Canada and the US. There are some suggestions that there may be more overuse of care in the United States than Canada, but there has been little study in children.
We compared the use of low-value diagnostic imaging rates from four pediatric emergency departments in Ontario to 26 in the United States from 2006 to 2016. We defined low-value imaging as situations where children are discharged from an emergency department with a diagnosis for which routine use of diagnostic imaging may not be necessary, like asthma or constipation.
MedicalResearch.com: What are the main findings?
Response: We found lower rates of low-value imaging in Ontario than the United States. This finding was most pronounced for diagnostic imaging associated with radiation exposure like plain radiographs and CT scans for gastrointestinal disorders like constipation and abdominal pain, and for concussion. Although not commonly used in either country, abdominal CT scans use was approximately 10-fold lower in Canada than the US for both constipation and abdominal pain. Lower imaging rates in Canada were not found to be associated with adverse outcomes like future hospitalization, intensive care unit admissions, surgery, or death.
MedicalResearch.com: What should readers take away from your report?
Response: There may be opportunities to safely reduce low-value imaging in pediatric emergency departments in the United States to better align resource use with high-quality care delivery.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We limited our study to pediatric emergency departments. Many children receive emergency care in other types of emergency departments like those in general hospitals. It would be beneficial to assess rates of low-value imaging in these type of settings to potentially identify other locations to target low-value imaging.
Low-Value Diagnostic Imaging Use in the Pediatric Emergency Department in the United States and Canada
JAMA Pediatrics Pub Date : 2019-06-03 , DOI: 10.1001/jamapediatrics.2019.1439
Eyal Cohen, Jonathan Rodean, Christina Diong, Matt Hall, Stephen B. Freedman, Paul L. Aronson, Harold K. Simon, Jennifer R. Marin, Margaret Samuels-Kalow, Elizabeth R. Alpern, Rustin B. Morse, Samir S. Shah, Alon Peltz, Mark I. Neuman
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