Imaging appropriateness in pediatric emergency department using the American College of Radiology criteria: an observational study

BACKGROUND: Even though children are typically more susceptible to radiation-induced illnesses than adults, pediatric radiology is an essential part of contemporary practice. Consequently, one of the most important performance metrics for patient safety is the appropriateness of radiologic procedures. The appropriateness criteria of the American College of Radiology (ACR) are evidence-based guidelines designed to assist referring physicians and other healthcare providers in decision-making regarding diagnostic imaging. METHODS: Using ACR criteria as a reference, this study attempts to assess the suitability of radiologic procedures sought by pediatric emergency physicians. Furthermore, the investigation ought to pinpoint and emphasize possible causes of improper requests. A trainee operator consecutively collected 462 requests for radio diagnostic imaging for neurological diseases of the emergency department of an Italian pediatric hospital and used the pediatric panel of ACR criteria to rate the appropriateness of each request. RESULTS: Due to the absence of crucial clinical information, 24.7% of the requests were not complete. Of the complete requests, only 16.1% were classified as "usually appropriate", 29.9% as "may be appropriate", and 54.0% as "usually not appropriate". CT requests were commonly inappropriate (55.7%, p < 0.01). CONCLUSION: Overuse of CT scans can result in costly procedures and unwarranted radiation exposure. In pediatric practice, communication between radiologists and emergency physicians should encourage the use of evidence-based decision-making.