Factors associated with imaging modality choice in children with appendicitis

Area of Science:

• Pediatric imaging and appendectomy outcomes.
• Radiological imaging modalities in pediatric surgery.

Background:

• Appendicitis is a common surgical emergency in children.
• Imaging plays a crucial role in diagnosing appendicitis and guiding treatment decisions.
• Different imaging modalities, including ultrasound (US) and computed tomography (CT), are used, each with potential benefits and drawbacks.

Purpose of the Study:

• To evaluate factors associated with the choice of imaging modality (CT alone vs. US alone vs. US and CT) in children undergoing appendectomy.
• To compare negative appendectomy and perforated appendicitis rates across different imaging strategies.

Main Methods:

• Analysis of the Kids' Inpatient Database for children aged 1-18 years who underwent imaging prior to appendectomy.
• Logistic regression models were employed to identify factors influencing the use of CT-alone imaging.
• Comparison of negative appendectomy and perforation rates based on imaging modality.

Main Results:

• CT alone was the most frequent imaging modality (69.5%), followed by US alone (22.1%) and US and CT combined (8.4%).
• Negative appendectomy rates were significantly higher with US alone (6.5%) and US/CT (6.6%) compared to CT alone (3.6%).
• Perforated appendicitis rates were highest in the US and CT group (36.3%). Older age and male sex were associated with CT-alone use, while children's centers, teaching hospitals, and urban locations were associated with lower CT-alone use.

Conclusions:

• Patient factors like age and sex influence imaging modality selection for pediatric appendectomy.
• Children's centers utilize less CT-alone imaging compared to non-children's centers, suggesting opportunities for optimizing imaging practices.
• Hospital characteristics play a significant role in imaging modality choices, highlighting areas for potential improvement in limiting CT use in children.