Use and accuracy of diagnostic imaging in the evaluation of pediatric appendicitis

• Published in: Journal of pediatric surgery 2015-04, Vol.50 (4), p.642-646
• Main Authors: Kotagal, Meera, Richards, Morgan K, Flum, David R, Acierno, Stephanie P, Weinsheimer, Robert L, Goldin, Adam B
• Format: Article
• Language: English
• Subjects: Acute Disease; Adolescent; Adult; Appendectomy; Appendicitis; Appendicitis - diagnosis; Appendicitis - surgery; Child; Child, Preschool; Diagnostic Imaging - standards; Diagnostic Imaging - utilization; Female; Humans; Male; Patient safety; Pediatrics; Quality Improvement; Reproducibility of Results; Surgery; Tomography, X-Ray Computed - standards; Tomography, X-Ray Computed - utilization; Washington
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2014.09.080

Abstract Background There are safety concerns about the use of radiation-based imaging (computed tomography [CT]) to diagnose appendicitis in children. Factors associated with CT use remain to be determined. Methods For patients ≤18 years old undergoing appendectomy, we evaluated diagnostic imaging performed, patient characteristics, hospital type, and imaging/pathology concordance (2008–2012) using data from Washington State’s Surgical Care and Outcomes Assessment Program. Results Among 2538 children, 99.7% underwent pre-operative imaging. 52.7% had a CT scan as their first study. After adjustment, age >10 years (OR 2.9 (95% CI 2.2–4.0), Hispanic ethnicity (OR 1.7, 95% CI 1.5–1.9), and being obese (OR 1.7, 95% CI 1.4–2.1) were associated with CT use first. Evaluation at a non-children’s hospital was associated with higher odds of CT use (OR 7.9, 95% CI 7.5–8.4). Ultrasound concordance with pathology was higher for males (72.3 vs. 66.4%, p = .03), in perforated appendicitis (75.9 vs. 67.5%, p = .009), and at children’s hospitals compared to general adult hospitals (77.3 vs. 62.2%, p < .001). CT use has decreased yearly statewide. Conclusions Over 50% of children with appendicitis had radiation-based imaging. Understanding factors associated with CT use should allow for more specific QI interventions to reduce radiation exposure. Site of care remains a significant factor in radiation exposure for children.