Rates of Concurrent Computed Tomography Imaging Following Ultrasound for Pediatric Patients With Appendicitis

• Published in: The Journal of surgical research 2024-10, Vol.302, p.134-143
• Main Authors: Scaife, Jack H., Iantorno, Stephanie E., Bucher, Brian T.
• Format: Article
• Language: English
• Subjects: Appendicitis; Imaging disparities; Pediatric surgery; Surgical disparities; Ultrasound access
• ISSN: 0022-4804; 1095-8673; 1095-8673
• DOI: 10.1016/j.jss.2024.06.048

Imaging guidelines recommend an ultrasound (US)–first approach to evaluate appendicitis to minimize radiation. However, the association between US and computed tomography (CT) utilization remains unclear. We aimed to determine how increased US utilization correlated with the rate of CT evaluation of pediatric acute appendicitis. We conducted a retrospective cohort study using the 2019 Nationwide Emergency Department Sample. Eligible patients were aged less than 18 y with a diagnosis of appendicitis. Imaging was determined by Current Procedural Terminology codes. Concurrent imaging was defined as US and CT use during the same encounter. We calculated the hospital rate of concurrent imaging and categorized hospitals into tertiles: low (< 20%), medium (20%-40%), and high (> 40%). We developed generalized ordinal logistic regression models with inverse probability weighting to assess patient characteristics and hospital rates of concurrent imaging associations. Our analysis included 485 hospitals and 23,976 patients. Thirty four percent were treated at hospitals in the lowest, 35% at the middle, and 31% at the highest tertile hospitals. We observed a negative correlation (−0.27, P