Ionizing Radiation Exposure Inequities in the Diagnostic Imaging of Children With Complex Chronic Conditions.

Abstract

Although limiting ionizing radiation exposure is a core tenet of pediatric medical imaging, inequities in ionizing radiation exposure may exist for children with complex chronic conditions (CCCs). Our objective was to compare the likelihood of ionizing radiation exposure in children with and without CCCs. Retrospective analysis of emergency department and inpatient encounters for children aged younger than 18 years (January 1, 2022, to December 31, 2023) in 47 children's hospitals in the Pediatric Health Information System (PHIS) database. The primary outcome was ionizing radiation exposure in medical imaging. Children with CCCs were distinguished by International Classification of Diseases, Tenth Revision (ICD-10) codes and greedy matched (1:1) to children without CCCs. Additional longitudinal analysis followed patients for 1 year. Multivariable analysis assessed likelihood of imaging-related exposure in children with CCCs. Children with neurologic/neuromuscular (N/NM) CCC and CT exposure were analyzed separately. A total of 1 013 034 encounters met inclusion criteria, and 292 300 patients were followed for 1 year. Encounters for children with an N/NM or other CCC had a greater likelihood of radiation exposure (aOR 1.52 [95% CI 1.49-1.54]; 1.27 [95% CI 1.26-1.28], respectively). Longitudinally, children with N/NM CCCs had highest likelihood of cumulative ionizing radiation exposure (IRE) (aOR 3.31 [95% CI 3.15-3.49]), followed by children with other CCCs (aOR 2.15 [95% CI 2.07-2.23]). Children with an N/NM CCC and other CCC were more likely to receive multiple (4+) CTs over 1 year (aOR 2.57 [95% CI 2.37-2.79]; aOR 1.54 [95% CI 1.44-1.64], respectively). Children with CCCs, particularly N/NM, are disproportionately exposed to radiation in medical imaging, with substantial repeated exposures longitudinally.