Table 2.

Studies addressing the effect of the type of facility and physician training on CT usage in children in emergency departments

Teaching hospitals vs non-teaching facilities
Hoshiko et al16	An earlier and more considerable decline in CT rates was demonstrated in teaching hospitals during the study period (2005–2012).
Marin et al48	Non-academic non-paediatric EDs had higher odds of using any type of CT during injury-related visits [OR = 1.51, 95% CI (1.16 to 1.96)].
Saito et al49	Children who were initially evaluated for appendicitis in a community hospital were about 4.5 times more likely to have a CT scan and were less likely to have an abdominal ultrasound as compared to an academic centre.
Blackwell et al50	This study demonstrated no differences in CT use between teaching and non-teaching facilities (21% CT usage rate in each).
Paediatric-specific facilities vsgeneral hospitals
Adelgais et al17	Cervical spine CT usage has increased particularly in children originally assessed at general EDs (from 6.8 to 42.0%), as compared to patients in paediatric specific facilities (from 3.5 to 16.1%) between 2002 and 2011.
Wylie et al10	Paediatric training and higher paediatric volumes were associated with less frequent use of head CT.
Blackwell et al50	CT was used more frequently in general EDs (22%) than in paediatric-specific EDs (13%) during the study period (1995–2003).
Neff et al43	Patients who initially presented at a referral hospital were more likely to undergo CT scan for presumed acute appendicitis than patients presented at a children’s hospital. In addition, the Alvarado score has been effective in preventing unneeded CT scans in the children’s hospital, but was not taken into account in the referral hospitals.
Michailidou et al51	Children that presented at a referral institution with acute abdominal pain had a 5-fold larger likelihood to receive a CT scan, compared to children presented at a paediatric ED.
Physician training type
Stanley et al52	Physician training type was associated with variability in CT use, with the greatest overall rate of CT use in physicians with emergency medicine training alone, and the lowest overall rate of CT use in paediatric residents.
Miescier et al42	Overall CT use at a specific paediatric hospital ED varied over a 3-fold range, with a significant variation even among the paediatric emergency medicine physicians group.
Grim et al53	Emergency medicine physicians who saw adults and children used CT significantly more frequently (37% of children) in the evaluation of abdominal pain in children compared to paediatricians (15%).