Advanced Imaging for Pediatric - PowerPoint Presentation

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Advanced Imaging for Pediatric Febrile Seizures

When to Image Based on Choosing Wisely® and ACR Appropriateness Criteria®

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What Is R-SCAN?

2Collaborative activity for referring clinicians and radiologists to improve patient

care through

clinical improvement

R-SCAN Collaboration Goals:

Ensure

patients receive the most appropriate imaging exam at the most appropriate time based on evidence-based appropriate use

criteria

Reduce

unnecessary imaging tests focused on imaging

Choosing Wisely

®

topics

Lower

the cost of care

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Why Participate?

R-SCAN Offers:Data-driven system for moving toward value-based imaging and patient care

Opportunity to focus

on highly relevant imaging exams to improve

utilization

Collaborators can fulfill their Improvement Activity requirements under the MIPS

Easy way

to practice with clinical decision support (CDS) technology In preparation for PAMAFree and immediate access to Web-based tools and CME activities

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Problem: Neuroimaging is not necessary in a child with simple febrile seizure

Published guidelines recommend that neuroimaging not be performed as part of the workup of a child with a simple febrile seizureRisks of these tests outweigh the benefits and are unlikely to change outcome

Risks include:

Radiation risk with CT

Sedation rand anesthesia medication risks

Management of incidental findings

Cost of diagnostic imaging

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Using Evidence to Guide Imaging Ordering

Choosing Wisely campaignCollaborative effort between ABIM Foundation and over 70 medical specialty societies

Helps patients and medical professionals avoid

wasteful or unnecessary medical tests, treatments and

procedures

The American Academy of Pediatrics agrees that there are situations when advanced imaging is inappropriate for a simple febrile seizure in a child

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Using Evidence to Guide Imaging Ordering

ACR Appropriateness Criteria®Assist referring physicians and other providers in making the most appropriate imaging or treatment decisions for specific clinical conditionsEmploys input of physicians from other medical specialties and societies to provide important clinical perspectives

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ACR Appropriateness Criteria: The Facts

178 clinical imaging topics and over 875 clinical variants

 

Basic access is

free

Learn more at

acr.org/ac

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Variant 1:

Neonatal seizuresVariant 2: Simple febrile seizuresVariant 3: Complex febrile seizures

Variant 4:

Post-traumatic seizures

Variant

5:

Partial seizuresVariant 6: First generalized seizure (neurologically normal)Variant 7: Generalized seizures (neurologically abnormal)

Variant

8:

Intractable or refractory seizures

ACR Appropriateness Criteria for

Pediatric Seizures

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Appropriateness Criteria Rating by Value

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Alignment of Appropriateness Criteria and Choosing Wisely

All imaging variants and clinical scenarios: https://acsearch.acr.org/docs/69441/Narrative/

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Alignment of Appropriateness Criteria and Choosing Wisely

All imaging variants and clinical scenarios: https://acsearch.acr.org/docs/69441/Narrative/

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Alignment of Appropriateness Criteria and Choosing Wisely

All imaging variants and clinical scenarios: https://acsearch.acr.org/docs/69441/Narrative/

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Alignment of Appropriateness Criteria and Choosing Wisely

All imaging variants and clinical scenarios: https://acsearch.acr.org/docs/69441/Narrative/

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Alignment of Appropriateness Criteria and Choosing Wisely

All imaging variants and clinical scenarios: https://acsearch.acr.org/docs/69441/Narrative/

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Alignment of Appropriateness Criteria and Choosing Wisely

All imaging variants and clinical scenarios: https://acsearch.acr.org/docs/69441/Narrative/

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Alignment of Appropriateness Criteria and Choosing Wisely

All imaging variants and clinical scenarios: https://acsearch.acr.org/docs/69441/Narrative/

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Alignment of Appropriateness Criteria and Choosing Wisely

All imaging variants and clinical scenarios: https://acsearch.acr.org/docs/69441/Narrative/

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When to Use Imaging for Pediatric Febrile Seizures

For a simple febrile seizure, any imaging—CT, MR, or US would not be appropriate. For a complex febrile seizure that includes one or more of the following—an MRI of the head MAY be appropriate (rated 4

).

P

rolonged

(lasting more than 15 minutes

)

Focal seizureOccurs more than once in 24 hours18

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R-SCAN and Clinical Decision Support

CareSelect is a web-based version ACR Appropriateness Criteria, comprising over 3,000 clinical scenarios and 15,000 imaging indications

CareSelect

provides evidence-based

decision support for the appropriate utilization

of

medical imaging

proceduresR-SCAN participants gain free access to a customized, web-based version of CareSelect, a helpful first step for aligning ordering patterns with appropriate use criteria

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rscan.org

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Getting Started

With

R-SCAN

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R-SCAN Pediatric Febrile Seizures Educational Resources

Visit: rscan.orgClick: ResourcesClick: Topic-specific Resources

Podcast

Imaging Order Simulation activity

Articles

Materials to share

with patients

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R-SCAN Resources With CME

Podcast A radiologist and referring physician discuss strategies of image ordering for cases of pediatric febrile seizures; approved for .5 CMELearn more

Imaging Order

Simulation Activity

Test your knowledge in selecting the

best imaging exam

for various indications

Free with CME26

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Key Points: Talking With Parents

Here are some frequently asked questions parents/caregivers may have prior to discharge: Is my child brain damaged?There is no evidence of impact on learning abilities after seizure from SFS.

Will this happen again?

If child is under 12 months of age at time of first seizure, recurrence rate is 50

%.

If child is greater than 12 months of age at time of first seizure, recurrence rate is 30

%.

Most recurrences occur within 6-12 months of the initial febrile seizure.

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Key Points: Talking With Parents

Here are some frequently asked questions parents/caregivers may have prior to discharge: Will my child get epilepsy?For simple febrile seizures, there is no increased risk of

epilepsy. For complex febrile seizures, there is a slight increase in the risk of epilepsy.

Why not treat for possible seizures or fever?

Anticonvulsants can reduce recurrence. However potential side effects of medications outweigh the minor risk of

recurrence.

Prophylactic use of antipyretics does not have impact on recurrence.

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Key Points: Talking With Parents

Instruct parent/caregivers to prevent injury during a seizure:Position child while seizing in a side-lying position Protect head from injury

Loosen tight clothing about the neck

Prevent injury from falls

Reassure child during event

Do not

place anything in the child

’s mouth

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Self-Assessment Question 1

Which of the following are true of simple febrile seizures?Indicate an underlying neurological conditionRequire anticonvulsant medication

Occur in children aged 6 months to 5 years

Frequently lead to epilepsy

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Self-Assessment Question 2

Which of the following are important history questions?Was there trauma?What did the seizure look like?

What medications and herbal supplements are the patient taking?

All of the above

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Self-Assessment Question 3

Diagnostic workup in the ED is based on suspicions of which of the following?MeningitisTrauma

Unknown immunization status

All of the above

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Self-Assessment Question 4

Discharge education should instruct the parents on which of the following?Scheduling an EEGActions to take to protect the child from injury during a seizure

Importance of a follow-up MRI

Anticonvulsant medications

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Summary

Advanced imaging such as MRI or CT is not indicated in the case of a simple febrile seizure in a child. Risks are associated with advanced imaging, including radiation risk with CT, sedation (anesthesia), incidental findings.Diagnostic neuroimaging is expensive and may not benefit or change management.36

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Questions?

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