Identifying opportunities to reduce imaging overuse in hospitalized children

Radiologic imaging is routinely performed to aid in diagnosis for hospitalized children. Identifying and reducing variability in imaging practices can improve care while reducing harms and costs. To identify common inpatient pediatric conditions with high prevalence of imaging and variation in imaging practices and imaging-related costs across hospitals. We conducted a cross-sectional study of children 0-18 years old admitted to 50 children's hospitals in the Pediatric Health Information Systems database between 2017 and 2019. We excluded patients with complex chronic conditions, pregnancy, newborn, or neonatal intensive care charges, and those who died or who were discharged to hospice or rehabilitation facilities. Conditions with at least 2500 discharges and in which ≥30% of patients received imaging were included. Outcomes included imaging frequency, standardized imaging-related costs (including all modalities across all encounters), and hospital-level variation in imaging costs using the intraclass correlation coefficient (ICC). Of the 56 included conditions, imaging was most frequently conducted in patients with pectus excavatum (97.8%), scoliosis (96.2%), and intestinal obstruction (96%). Fracture ($21.4 million), trauma ($15.7 million), and appendicitis ($8.6 million) had the highest total imaging-related costs. Conditions with the highest geometric mean standardized imaging costs were nervous system disorders ($507), osteomyelitis ($494), vesicoureteral reflux/hydronephrosis ($468). Scoliosis (ICC = 0.49) and preseptal cellulitis (ICC = 0.48) had the highest variation in imaging-related costs. To reduce imaging overuse in hospitalized children, conditions with frequent imaging, high imaging-related costs, and high hospital-level variation in imaging practices should serve as priorities for future evidence generation, guideline development, and/or improvement initiatives.