Justification for Head Computed Tomography in Pediatric Patients in a Tertiary Hospital in Jeddah, Saudi Arabia

Abstract

Imaging justification considers the risk–benefit ratio to avoid
unnecessary radiation exposure. The use of high-radiationdose imaging modalities, including computed tomography, has
increased. In Saudi Arabia, no clear guidelines exist for protecting
pediatric patients from unnecessary exposure to ionizing
radiation. We aimed to investigate the frequency of unjustified
head computed tomography scans among pediatric patients at
our hospital. In this study, we enrolled pediatric patients (0–14
years old) who underwent head computed tomography scans
between September 2015 and September 2017, and evaluated
the frequency of unjustified scans. Among the 1,109 scans, 40.6%
(n = 450) had no findings; of these, 68.4% (n = 308) were justified
and 31.6% (n = 142) were not. The majority of “no finding” cases
were from the emergency department; (285 [63.3%]) and
were from patients >5 years old (203 [45.1%]). Thirty percent
of “no findings” cases from the emergency department were
not justified and 19% were incompatible with the modality.
Approximately 40% of cases from the outpatient departments
were neither justified nor compatible with this modality. Our
findings highlight the need for regular auditing to justify scan
requests and a clinical decision system for medical imaging
using ionizing radiation