Computerized tomography utilization in children with appendicitis-differences in referring and children's hospitals

Area of Science:

• Pediatric surgery
• Diagnostic imaging
• Medical decision-making

Background:

• Physicians increasingly use computerized tomography (CT) for pediatric acute appendicitis (AA) diagnosis.
• Concerns exist regarding CT-associated radiation exposure in children.
• The decision-making context for CT use in pediatric AA is not well understood.

Purpose of the Study:

• To determine where the decision to use CT was made during the initial workup of pediatric patients undergoing appendectomy.
• To compare CT utilization rates between a children's hospital (CH) and referring hospitals (RHs).

Main Methods:

• Retrospective review of medical records for pediatric patients undergoing appendectomy over 10.5 years.
• Abstraction of clinical variables using an established AA scoring system, demographics, and outcomes.
• Comparison of CT utilization between CH and RHs, and by AA score within CH.

Main Results:

• 50% of 546 pediatric appendectomy patients underwent CT.
• Patients initially presenting at RHs underwent CT at a significantly higher rate than those at CH (P < 0.0001).
• At CH, patients with higher AA scores underwent CT less often than at RHs (P < 0.0002).

Conclusions:

• Referring hospitals used CT more frequently than the children's hospital for diagnosing pediatric AA.
• The children's hospital demonstrated a trend towards avoiding CT in patients with higher AA scores.
• Further research is needed to optimize CT use for suspected pediatric AA and minimize radiation exposure.