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Use and accuracy of diagnostic imaging by hospital type in pediatric appendicitis.

Abstract：

OBJECTIVE:Accurate, timely diagnosis of pediatric appendicitis minimizes unnecessary operations and treatment delays. Preoperative abdominal-pelvic computed tomography (CT) scan is sensitive and specific for appendicitis; however, concerns regarding radiation exposure in children obligate scrutiny of CT use. Here, we characterize recent preoperative imaging use and accuracy among pediatric appendectomy subjects. METHODS:We retrospectively reviewed children who underwent operations for presumed appendicitis at a single tertiary-care children's hospital and examined preoperative CT and ultrasound use with subject characteristics. Preoperative imaging accuracy was compared with postoperative and histologic diagnosis as the reference standard. RESULTS:Most children (395/423, 93.4%) who underwent an operation for appendicitis during 2009-2010 had preoperative imaging. Final diagnoses included normal appendix (7.3%) and perforated appendicitis (23.6%). In multivariable analysis, initial evaluation at a community hospital versus the children's hospital was associated with 4.4-fold higher odds of obtaining a preoperative CT scan (P = .002), whereas preoperative ultrasound was less likely (odds ratio 0.20; P = .003). Ultrasound and CT sensitivities for appendicitis were diminished for studies performed at community hospitals compared with the children's hospital. Girls were 4.5-fold more likely to undergo both ultrasound and CT scans and were associated with lower ultrasound sensitivity for appendicitis. CONCLUSIONS:Widespread preoperative imaging did not eliminate unnecessary pediatric appendectomies. Controlling for factors potentially associated with referral bias, a CT scan was more likely to be performed in children initially evaluated at community hospitals compared with the children's hospital. Broadly-applicable strategies to systematically maximize diagnostic accuracy for childhood appendicitis, while minimizing ionizing radiation exposure, are urgently needed.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Saito JM,Yan Y,Evashwick TW,Warner BW,Tarr PI

doi

10.1542/peds.2012-1665

subject

Has Abstract

pub_date

2013-01-01 00:00:00

pages

e37-44

issue

eissn

0031-4005

issn

1098-4275

pii

peds.2012-1665

journal_volume

131

pub_type

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Use and accuracy of diagnostic imaging by hospital type in pediatric appendicitis.