OBJECTIVES: Evaluate nationwide 12-year trend and hospital-level variation in head computed tomography (CT) utilization among infants admitted to pediatric hospital NICUs. We hypothesized there was significant variation in utilization.

METHODS: We conducted a retrospective cohort study examining head CT utilization for infants admitted to the NICU within 31 United States children's hospitals within the Pediatric Health Information System database between 2010 and 2021. Mixed effects logistic regression was used to estimate head CT, head MRI, and head ultrasound utilization (% of admissions) by year. Risk-adjusted hospital head CT rates were examined within the 2021 cohort.

RESULTS: Between 2010 and 2021, there were 338 644 NICU admissions, of which 10 052 included head CT (3.0%). Overall, head CT utilization decreased (4.9% in 2010 to 2.6% in 2021, P < .0001), with a concomitant increase in head MRI (12.1% to 18.7%, P < .0001) and head ultrasound (41.3% to 43.4%, P < .0001) utilization. In 2021, significant variation in risk-adjusted head CT utilization was noted across centers, with hospital head CT rates ranging from 0% to 10% of admissions. Greatest hospital-level variation was noted for patients with codes for seizure or encephalopathy (hospital head CT rate interquartile range [IQR] = 11.6%; 50th percentile = 12.0%), ventriculoperitoneal shunt (IQR = 10.8%; 50th percentile = 15.4%), and infection (IQR = 10.1%; 50th percentile = 7.5%).

CONCLUSIONS: Head CT utilization within pediatric hospital NICUs has declined over the past 12-years, but substantial hospital-level variation remains. Development of CT stewardship guidelines may help decrease variation and reduce infant radiation exposure.

OBJECTIVES: Evaluate nationwide 12-year trend and hospital-level variation in head computed tomography (CT) utilization among infants admitted to pediatric hospital NICUs. We hypothesized there was significant variation in utilization.

METHODS: We conducted a retrospective cohort study examining head CT utilization for infants admitted to the NICU within 31 United States children's hospitals within the Pediatric Health Information System database between 2010 and 2021. Mixed effects logistic regression was used to estimate head CT, head MRI, and head ultrasound utilization (% of admissions) by year. Risk-adjusted hospital head CT rates were examined within the 2021 cohort.

RESULTS: Between 2010 and 2021, there were 338 644 NICU admissions, of which 10 052 included head CT (3.0%). Overall, head CT utilization decreased (4.9% in 2010 to 2.6% in 2021, P < .0001), with a concomitant increase in head MRI (12.1% to 18.7%, P < .0001) and head ultrasound (41.3% to 43.4%, P < .0001) utilization. In 2021, significant variation in risk-adjusted head CT utilization was noted across centers, with hospital head CT rates ranging from 0% to 10% of admissions. Greatest hospital-level variation was noted for patients with codes for seizure or encephalopathy (hospital head CT rate interquartile range [IQR] = 11.6%; 50th percentile = 12.0%), ventriculoperitoneal shunt (IQR = 10.8%; 50th percentile = 15.4%), and infection (IQR = 10.1%; 50th percentile = 7.5%).

CONCLUSIONS: Head CT utilization within pediatric hospital NICUs has declined over the past 12-years, but substantial hospital-level variation remains. Development of CT stewardship guidelines may help decrease variation and reduce infant radiation exposure.

We conducted a study to assess test characteristics of red-flag criteria for identifying cardiac disease causing chest pain and technical charges of low-probability referrals. Accuracy of red-flag criteria was ascertained through study of chest pain Standardized Clinical Assessment and Management Plans (SCAMPs®) data. Patients were divided into 2 groups: Group1 (concerning clinical elements) and Group2 (without). We compared incidence of cardiac disease causing chest pain between these 2 groups. Technical charges of Group 2 were analyzed using the Pediatric Health Information System database. Potential savings for the US population was estimated using National Ambulatory Medical Care Survey data. Fifty-two percent of subjects formed Group 1. Cardiac disease causing chest pain was identified in 8/1656 (0.48%). No heart disease was identified in patients in Group 2 ( P = .03). Applying red-flags in determining need for referral identified patients with cardiac disease causing chest pain with 100% sensitivity. Median technical charges for Group 2, over a 4-year period, were US2014$775 559. Eliminating cardiac testing of low-probability referrals would save US2014$3 775 182 in technical charges annually. Red-flag criteria were an effective screen for children with chest pain. Eliminating cardiac testing in children without red-flags for referral has significant technical charge savings.