Supplementary Material for: Changing Trends in Brain Imaging Technique for Pediatric Patients with Ventriculoperitoneal Shunts

<p><b><i>Background:</i></b> Children with ventriculoperitoneal shunts (VPS) undergoing brain computed tomography (CT) for shunt malfunction evaluation are at risk for later malignancy due to radiation exposure. We aimed to determine if and how hospitals have adopted radiation-avoiding magnetic resonance imaging (MRI) techniques. <b><i>Methods:</i></b> We performed a secondary analysis of the Pediatric Health Information System (PHIS) database. Children with VPS presenting to acute wards at 31 PHIS hospitals between January 1, 2007 and January 2, 2015 and receiving noncontrast neuroimaging on day of service 0/1 were included. Outcome measures were (1) incidence of MRI over time and (2) comparison of demographic characteristics between hospitals with MRI representing higher versus lower proportions (>15% or <15%) of total brain imaging. <b><i>Results:</i></b> MRIs increased by 18.1% from 2007 to 2015. Hospitals were assigned to high-use (<i>n</i> = 12) or minimal-use (<i>n</i> = 19) MRI groups based on year 2014/2015 MRI percentages. The only identified difference was an older mean age in the high-use group (8.1 vs. 7.5 years; <i>p</i> = 0.03). <b><i>Conclusions:</i></b> MRI is increasingly used to evaluate patients with VPS. Hospitals with more MRI use had older patients and no increase in cost or length of stay. Initiating local quality improvement projects may help identify barriers to MRI uptake and increase use.</p>

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