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American Academy of Pediatrics
Article

Use of and Regional Variation in Initial CT Imaging for Kidney Stones

Gregory E. Tasian, Jose E. Pulido, Ron Keren, Andrew W. Dick, Claude M. Setodji, Jan M. Hanley, Rodger Madison and Christopher S. Saigal
Pediatrics November 2014, 134 (5) 909-915; DOI: https://doi.org/10.1542/peds.2014-1694
Gregory E. Tasian
aDivision of Pediatric Urology, Department of Surgery,
bDivision of Urological Surgery, Department of Surgery, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania;
cCenter for Pediatric Clinical Effectiveness, and
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Jose E. Pulido
bDivision of Urological Surgery, Department of Surgery, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania;
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Ron Keren
cCenter for Pediatric Clinical Effectiveness, and
dDepartment of Pediatrics, The Children’s Hospital of Philadelphia; Philadelphia, Pennsylvania;
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Andrew W. Dick
eRAND Corporation, Santa Monica, California; and
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Claude M. Setodji
eRAND Corporation, Santa Monica, California; and
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Jan M. Hanley
eRAND Corporation, Santa Monica, California; and
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Rodger Madison
eRAND Corporation, Santa Monica, California; and
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Christopher S. Saigal
eRAND Corporation, Santa Monica, California; and
fDepartment of Urology, University of California, Los Angeles, Los Angeles, California
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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.

  • nephrolithiasis
  • computed tomography
  • ultrasound
  • children
  • Accepted August 28, 2014.
  • Copyright © 2014 by the American Academy of Pediatrics

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Pediatrics
Vol. 134, Issue 5
1 Nov 2014
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Use of and Regional Variation in Initial CT Imaging for Kidney Stones
Gregory E. Tasian, Jose E. Pulido, Ron Keren, Andrew W. Dick, Claude M. Setodji, Jan M. Hanley, Rodger Madison, Christopher S. Saigal
Pediatrics Nov 2014, 134 (5) 909-915; DOI: 10.1542/peds.2014-1694

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Use of and Regional Variation in Initial CT Imaging for Kidney Stones
Gregory E. Tasian, Jose E. Pulido, Ron Keren, Andrew W. Dick, Claude M. Setodji, Jan M. Hanley, Rodger Madison, Christopher S. Saigal
Pediatrics Nov 2014, 134 (5) 909-915; DOI: 10.1542/peds.2014-1694
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