The appropriate use of CT: quality improvement and clinical decision-making in pediatric emergency medicine

An increasing number of patients presenting to a shrinking number of hospital emergency departments has contributed to challenges to providing high-quality care, specifically care that is safe, efficient and effective. These challenges are magnified by trends in CT utilization with uncertain implications for care delivery. The utility of CT poses challenges to the pediatric emergency medicine physician to balance risk with potential benefit. We describe the process of evidence-based clinical decision-making to define the appropriate use of CT studies. Strategies for minimizing CT utilization in managing appendicitis, traumatic brain injury and cervical spine injuries are described. Clinical scores, clinical decision rules and evidence-based guidelines can assist the clinician in providing high-quality care through effective utilization of CT.