Purpose or Case Report: The practice of performing dedicated breast ultrasounds in the pediatric emergency department varies according to institution. In the adult population, breast ultrasounds are commonly interpreted by dedicated breast imagers and/or radiologists appropriately qualified to interpret mammograms. Children's hospitals with dedicated pediatric radiology faculty are less likely to have such individuals on staff. This paper examines the practice of breast ultrasounds ordered in the emergency department throughout a large children's health system.
Methods & Materials: This is a retrospective review performed throughout a large pediatric health system. All patient encounters of children presenting to any location within the health system undergoing breast ultrasound over a 16-year-period were reviewed. The encounters were then stratified according to indication, biological sex, age, and location/department presenting.
Results: A total of 3,459 breast ultrasounds were reviewed with 774 (22%) ordered from the emergency department. The mean age of patients presenting to the emergency department was 11.65 compared to 11.49 for non-emergency department patients. In the emergency department, 33% present of breast ultrasounds were ordered with an indication related to acute infection compared to 3% outside the emergency department. Emergency department patients were 12% male versus 16% male outside of the emergency department. Among males, 48% of breast ultrasounds in the emergency department were ordered for gynecomastia, breast lumps, or breast buds. Findings suggestive of fibroadenoma were uncovered in 15% of females in the emergency deparrment.
Conclusions: When pediatric emergency department providers have access to breast ultrasound, orders for non-acute breast complaints are common. Acute infectious states are more likely to result in ultrasound in the emergency department than outside the emergency department, but such ultrasounds represent the minority of emergency department breast ultrasounds. Children's hospital emergency departments may consider a more restrictive policy with regard to breast ultrasound utilization.