{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T19:44:02Z","timestamp":1776109442410,"version":"3.50.1"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To compare low-value computed tomography (CT) use during pediatric emergency department (ED) visits by hospital type and physician specialty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Repeated cross-sectional study using linked databases from Ontario, Canada. We reviewed pediatric ED discharges from 2010 to 2019 for 5 diagnoses with recommendations against routine CT use: abdominal pain, constipation, concussion, seizure, and headache. We evaluated CT use by hospital type (pediatric academic, adult academic, community with and without pediatric consultation) and provider specialty [pediatric emergency medicine (PEM), emergency medicine (EM), family medicine + EM, family medicine, pediatrician], using multivariable logistic regression, adjusting for patient, ED, and physician characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We included 599,948 pediatric ED discharges [mean (SD) age 10.8\u00a0y (5.3); 55.4% females]: 5000 (1.2%) discharges for abdominal diagnoses included a CT, and 21,398 (11.4%) discharges for neurological diagnoses included a CT. Children had an increased adjusted odds ratio [aOR (95% CI)] of receiving a CT at all hospital types compared with pediatric academic hospitals: adult academic hospitals ranging from 1.10 (1.01 to 1.21) for headache to 3.46 (1.89 to 6.36) for constipation, community hospitals with pediatric consultation ranging from 1.54 (1.45 to 1.63) for concussion to 3.74 (2.38-5.90) for constipation, and community hospitals without pediatric consultation ranging from 1.24 (1.15 to 1.33) for concussion to 2.29 (1.36 to 3.87) for constipation. Those patients seen by nonpediatric providers (EM, family medicine + EM, family medicine) were more likely to receive CT scans than PEM physicians for all diagnoses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Low-value CT use was higher among children treated in nonpediatric EDs and by nonpediatric providers. Improvement initiatives should target specific hospital types and specialties.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/pec.0000000000003473","type":"journal-article","created":{"date-parts":[[2025,8,23]],"date-time":"2025-08-23T05:00:08Z","timestamp":1755925208000},"page":"13-21","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Low-Value Computed Tomography for Children in the Emergency Department: A Repeated Cross-Sectional Study"],"prefix":"10.1097","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6096-5693","authenticated-orcid":false,"given":"Gabrielle C.","family":"Freire","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON"},{"name":"Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, ON"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Diong","sequence":"additional","affiliation":[{"name":"ICES, ON"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sima","family":"Gandhi","sequence":"additional","affiliation":[{"name":"ICES, ON"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natasha R.","family":"Saunders","sequence":"additional","affiliation":[{"name":"Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, ON"},{"name":"ICES, ON"},{"name":"Department of Pediatrics, Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON"},{"name":"Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark I.","family":"Neuman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Emergency Medicine, Boston Children\u2019s Hospital, Harvard Medical School, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen B.","family":"Freedman","sequence":"additional","affiliation":[{"name":"Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy N.","family":"Friedman","sequence":"additional","affiliation":[{"name":"Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, ON"},{"name":"Department of Pediatrics, Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eyal","family":"Cohen","sequence":"additional","affiliation":[{"name":"Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, ON"},{"name":"ICES, ON"},{"name":"Department of Pediatrics, Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON"},{"name":"Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2025,8,25]]},"reference":[{"key":"R1-20251230","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1186\/s12913-019-4277-9","article-title":"Measuring the frequency and variation of unnecessary care across Canada","volume":"19","author":"Bouck","year":"2019","journal-title":"BMC Health Serv Res"},{"key":"R3-20251230","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.jpeds.2021.02.003","article-title":"Low-value diagnostic imaging in children with Medicaid","volume":"235","author":"Marin","year":"2021","journal-title":"J Pediatr"},{"key":"R4-20251230","doi-asserted-by":"crossref","first-page":"20170434","DOI":"10.1259\/bjr.20170434","article-title":"Overuse of CT and MRI in paediatric emergency departments","volume":"91","author":"Ohana","year":"2018","journal-title":"Br J Radiol"},{"key":"R5-20251230","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1017\/cem.2016.349","article-title":"Reducing low-value interventions in the emergency department: you may be part of the problem","volume":"19","author":"Sahota","year":"2017","journal-title":"CJEM"},{"key":"R6-20251230","doi-asserted-by":"crossref","first-page":"20150819","DOI":"10.1259\/bjr.20150819","article-title":"Use of advanced imaging techniques during visits to emergency departments\u2014implications, costs, patient benefits\/risks","volume":"89","author":"Dick","year":"2016","journal-title":"Br J Radiol"},{"key":"R7-20251230","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1542\/peds.2007-1910","article-title":"Radiation risk to children from computed tomography","volume":"120","author":"Brody","year":"2007","journal-title":"Pediatrics"},{"key":"R8-20251230","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1007\/s00247-007-0743-3","article-title":"The \u201cImage Gently\u201d campaign: increasing CT radiation dose awareness through a national education and awareness program","volume":"38","author":"Goske","year":"2008","journal-title":"Pediatr Radiol"},{"key":"R11-20251230","doi-asserted-by":"crossref","first-page":"e202209","DOI":"10.1001\/jamapediatrics.2020.2209","article-title":"Trends in use of advanced imaging in pediatric emergency departments, 2009-2018","volume":"174","author":"Marin","year":"2020","journal-title":"JAMA Pediatr"},{"key":"R13-20251230","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1097\/MPG.0000000000000266","article-title":"Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN","volume":"58","author":"Tabbers","year":"2014","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"S2","key":"R14-20251230","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.1017\/cem.2017.1","article-title":"Choosing Wisely Canada\u00ae: five tests, procedures and treatments to question in emergency medicine","volume":"19","author":"Cheng","year":"2017","journal-title":"CJEM"},{"key":"R15-20251230","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.seizure.2015.12.009","article-title":"Yield of emergent neuroimaging in children with new-onset seizure and status epilepticus","volume":"35","author":"Lyons","year":"2016","journal-title":"Seizure"},{"key":"R17-20251230","doi-asserted-by":"crossref","first-page":"e191439","DOI":"10.1001\/jamapediatrics.2019.1439","article-title":"Low-value diagnostic imaging use in the pediatric emergency department in the United States and Canada","volume":"173","author":"Cohen","year":"2019","journal-title":"JAMA Pediatr"},{"key":"R18-20251230","first-page":"e19162","article-title":"The pattern of CT scan use in the diagnosis of abdominal pain in children presenting to the emergency department of a tertiary community hospital","volume":"13","author":"Khan","year":"2021","journal-title":"Cureus"},{"key":"R19-20251230","first-page":"1","article-title":"Head CT guidelines following concussion among the youngest trauma patients: can we limit radiation exposure following traumatic brain injury?","volume":"11","author":"Harvell","year":"2018","journal-title":"Kans J Med"},{"key":"R20-20251230","doi-asserted-by":"crossref","first-page":"e20170615","DOI":"10.1542\/peds.2017-0615","article-title":"US emergency department trends in imaging for pediatric nontraumatic abdominal pain","volume":"140","author":"Niles","year":"2017","journal-title":"Pediatrics"},{"key":"R21-20251230","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1148\/radiol.11101939","article-title":"Rising use of CT in child visits to the emergency department in the United States, 1995-2008","volume":"259","author":"Larson","year":"2011","journal-title":"Radiology"},{"key":"R22-20251230","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1111\/acem.13489","article-title":"Use of a national database to assess pediatric emergency care across United States Emergency Departments","volume":"25","author":"Michelson","year":"2018","journal-title":"Acad Emerg Med"},{"key":"R23-20251230","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1111\/acem.12458","article-title":"Variation in emergency department head computed tomography use for pediatric head trauma","volume":"21","author":"Marin","year":"2014","journal-title":"Acad Emerg Med"},{"key":"R24-20251230","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1016\/j.jpeds.2014.08.008","article-title":"Emergency department practice variation in computed tomography use for children with minor blunt head trauma","volume":"165","author":"Stanley","year":"2014","journal-title":"J Pediatr"},{"key":"R25-20251230","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1097\/PEC.0000000000000500","article-title":"Variation in computed tomography use for evaluation of head injury in a pediatric emergency department","volume":"33","author":"Miescier","year":"2017","journal-title":"Pediatr Emerg Care"},{"key":"R26-20251230","doi-asserted-by":"crossref","first-page":"e395","DOI":"10.1097\/pq9.0000000000000395","article-title":"Evidence-based standardization of constipation management in the emergency department: a quality improvement study","volume":"6","author":"Lipshaw","year":"2021","journal-title":"Pediatr Qual Saf"},{"key":"R27-20251230","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1111\/acem.14177","article-title":"Reducing computed tomography scan utilization for pediatric minor head injury in the emergency department: a quality improvement initiative","volume":"28","author":"Arora","year":"2020","journal-title":"Acad Emerg Med"},{"key":"R28-20251230","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1542\/peds.2014-1036","article-title":"Effectiveness of quality improvement in hospitalization for bronchiolitis: a systematic review","volume":"134","author":"Ralston","year":"2014","journal-title":"Pediatrics"},{"key":"R29-20251230","doi-asserted-by":"crossref","first-page":"E889","DOI":"10.9778\/cmajo.20210140","article-title":"Variation in low-value radiograph use for children in the emergency department: a cross-sectional study of administrative databases","volume":"10","author":"Freire","year":"2022","journal-title":"CMAJ Open"},{"key":"R30-20251230","doi-asserted-by":"crossref","first-page":"e1001885","DOI":"10.1371\/journal.pmed.1001885","article-title":"The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement","volume":"12","author":"Benchimol","year":"2015","journal-title":"PLoS Med"},{"key":"R31-20251230","doi-asserted-by":"crossref","first-page":"e0123746","DOI":"10.1371\/journal.pone.0123746","article-title":"Differences in access to services in rural emergency departments of Quebec and Ontario","volume":"10","author":"Fleet","year":"2015","journal-title":"PLoS One"},{"key":"R32-20251230","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.annemergmed.2013.02.018","article-title":"Emergency department computed tomography utilization in the United States and Canada","volume":"62","author":"Berdahl","year":"2013","journal-title":"Ann Emerg Med"},{"key":"R33-20251230","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/s12911-016-0375-3","article-title":"Describing the linkages of the immigration, refugees and citizenship Canada permanent resident data and vital statistics death registry to Ontario\u2019s administrative health database","volume":"16","author":"Chiu","year":"2016","journal-title":"BMC Medical Informatics and Decision Making"},{"key":"R34-20251230","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1186\/1471-2431-14-199","article-title":"Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation","volume":"14","author":"Feudtner","year":"2014","journal-title":"BMC Pediatr"},{"key":"R35-20251230","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1017\/S1481803500010149","article-title":"Revisions to the Canadian Triage and Acuity Scale paediatric guidelines (PaedCTAS)","volume":"10","author":"Warren","year":"2008","journal-title":"CJEM"},{"key":"R36-20251230","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/1757-7241-17-38","article-title":"Reliability and validity of triage systems in paediatric emergency care","volume":"17","author":"van Veen","year":"2009","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"R38-20251230","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.3174\/ajnr.A5755","article-title":"Comparison of advanced imaging resources, radiology workforce, and payment methodologies between the United States and Canada","volume":"39","author":"Valand","year":"2018","journal-title":"AJNR Am J Neuroradiol"},{"key":"R39-20251230","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1056\/NEJMsa1012370","article-title":"Malpractice risk according to physician specialty","volume":"365","author":"Jena","year":"2011","journal-title":"N Engl J Med"},{"key":"R40-20251230","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12910-022-00755-2","article-title":"A qualitative interview study of Australian physicians on defensive practice and low value care: \u201cit\u2019s easier to talk about our fear of lawyers than to talk about our fear of looking bad in front of each other\u201d","volume":"23","author":"Ries","year":"2022","journal-title":"BMC Med Ethics"},{"key":"R41-20251230","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1001\/jamapediatrics.2013.25","article-title":"Influence of surgeon experience, hospital volume, and specialty designation on outcomes in pediatric surgery: a systematic review","volume":"167","author":"McAteer","year":"2013","journal-title":"JAMA Pediatr"},{"key":"R43-20251230","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1542\/peds.2004-2784","article-title":"Volume matters: physician practice characteristics and immunization coverage among young children insured through a universal health plan","volume":"117","author":"Guttmann","year":"2006","journal-title":"Pediatrics"},{"key":"R44-20251230","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1111\/acem.13564","article-title":"Adherence to pediatric cardiac arrest guidelines across a spectrum of fifty emergency departments: a prospective, in situ, simulation-based study","volume":"25","author":"Auerbach","year":"2018","journal-title":"Acad Emerg Med"},{"key":"R46-20251230","first-page":"157","article-title":"The volume-outcome relationship: practice-makes-perfect or selective-referral patterns?","volume":"22","author":"Luft","year":"1987","journal-title":"Health Serv Res"}],"container-title":["Pediatric Emergency Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000003473","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T04:00:23Z","timestamp":1767067223000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000003473"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,25]]},"references-count":38,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/pec.0000000000003473","relation":{},"ISSN":["0749-5161","1535-1815"],"issn-type":[{"value":"0749-5161","type":"print"},{"value":"1535-1815","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,25]]},"assertion":[{"value":"2025-05-05","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-28","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}