Use of and regional variation in initial CT imaging for kidney stones.

TitleUse of and regional variation in initial CT imaging for kidney stones.
Publication TypeJournal Article
Year of Publication2014
AuthorsTasian GE, Pulido JE, Keren R, Dick AW, Setodji CM, Hanley JM, Madison R, Saigal CS
Corporate AuthorsUrologic Diseases in America Project
JournalPediatrics
Volume134
Issue5
Pagination909-15
Date Published2014 Nov
ISSN1098-4275
KeywordsAdolescent, Child, Child, Preschool, Cross-Sectional Studies, Female, Humans, Infant, Male, Nephrolithiasis, Tomography, X-Ray Computed, United States
Abstract

OBJECTIVE: We sought to determine the prevalence of initial computed tomography (CT) utilization and to identify regions in the United States where CT is highly used as the first imaging study for children with nephrolithiasis.

METHODS: We performed a cross-sectional study in 9228 commercially insured children aged 1 to 17 years with nephrolithiasis who underwent diagnostic imaging in the United States between 2003 and 2011. Data were obtained from MarketScan, a commercial insurance claims database of 17,827,229 children in all 50 states. We determined the prevalence of initial CT use, defined as CT alone or CT performed before ultrasound in the emergency department, inpatient unit, or outpatient clinic, and identified regions of high CT utilization by using logistic regression.

RESULTS: Sixty-three percent of children underwent initial CT study and 24% had ultrasound performed first. By state, the proportion of children who underwent initial CT ranged from 41% to 79%. Regional variations persisted after adjusting for age, gender, year of presentation, and insurance type. Relative to children living in West South Central states, the highest odds of initial CT utilization were observed for children living in the East South Central US Census division (odds ratio: 1.27; 95% confidence interval: 1.06-1.54). The lowest odds of initial CT were observed for children in the New England states (odds ratio: 0.48; 95% confidence interval: 0.38-0.62).

CONCLUSIONS: Use of CT as the initial imaging study for children with nephrolithiasis is highly prevalent and shows extensive regional variability in the United States. Current imaging practices deviate substantially from recently published guidelines that recommend ultrasound as the initial imaging study.

DOI10.1542/peds.2014-1694
Alternate JournalPediatrics
PubMed ID25349323
PubMed Central IDPMC4210800
Grant ListHHSN276201200016C / / PHS HHS / United States
T32HD060550 / HD / NICHD NIH HHS / United States