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Ontario pediatric emergency departments order fewer low-value imaging tests than US counterparts


Lower use of imaging tests in Ontario pediatric emergency departments (EDs) was not associated with higher rates of poor outcomes, suggesting that use may be safely reduced in the United States, according to a new study by researchers at ICES and The Hospital for Sick Children (SickKids).

Choosing Wisely, a campaign targeting overuse of care that provides little benefit, was launched in 2012. Diagnostic imaging (e.g. MRIs, ultrasounds and x-rays) overuse in children seen in EDs accounts for three of the first five of the American Academy of Pediatrics Choosing Wisely recommendations and six of the 10 Choosing Wisely recommendations for emergency medicine in Canada. 

The study, published June 3rd in JAMA Pediatrics, compared the use of low-value diagnostic imaging rates from four pediatric EDs in Ontario to 26 in the United States from 2006 to 2016. The researchers looked at data for children 18 years and younger who were discharged from the ED during the study period with a diagnosis for which routine use of diagnostic imaging may not be necessary, like asthma or constipation.

“This finding was most pronounced for diagnostic imaging associated with radiation exposure such as plain radiographs and CT scans for concussion and gastrointestinal complaints like constipation and abdominal pain. Although not commonly used in either country, abdominal CT scan use was approximately 10-fold lower in Canada than the US for both constipation and abdominal pain,” says Dr. Eyal Cohen, lead author of the study, co-founder of the complex care program and interim head of the Child Health Evaluative Sciences program at SickKids, and adjunct scientist at ICES.

The researchers found lower imaging rates in Canada were not associated with future hospitalization, intensive care unit admissions, surgery, or death.

Minimizing care that provides little benefit to patients has become an important focus to decrease healthcare 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 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,” adds Cohen.

Author block: 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 and Mark I. Neuman.

The study “Low-value diagnostic imaging use in the pediatric emergency department in the United States and Canada,” is published in the June 3 issue of JAMA Pediatrics.

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario

About The Hospital for Sick Children (SickKids)
The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is a founding member of Kids Health Alliance, a network of partners working to create a high quality, consistent and coordinated approach to paediatric healthcare that is centred around children, youth and their families. SickKids is proud of its vision for Healthier Children. A Better World.

For more information, please contact:

Deborah Creatura
Media Advisor, ICES
[email protected]
(o) 416-480-4780 or (c) 647-406-5996

Jessamine Luck
Communications Advisor, SickKids
[email protected]
416-813-7654 ext. 201436


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