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Diagnostic imaging for acute appendicitis: interfacility differences in practice patterns
Maria Michailidou1, Maria G Sacco Casamassima, Omar Karim
1Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Insights
Children presenting to referring hospitals are more likely to receive CT scans for appendicitis diagnosis. Developing clinical pathways and promoting ultrasound can reduce radiation exposure.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Radiology
Background:
- Acute appendicitis is a common surgical emergency in children.
- Imaging modality selection can significantly impact diagnosis and management.
- Variations in imaging practices exist between healthcare facilities.
Purpose of the Study:
- To analyze trends and factors influencing imaging modality choices for pediatric acute appendicitis.
- To investigate interfacility differences in imaging for suspected appendicitis in children.
- To identify predictors of imaging selection in pediatric appendicitis.
Main Methods:
- Retrospective review of 232 pediatric appendectomies (2008-2013).
- Comparison of imaging selection between a children's hospital and referring institutions.
- Analysis of factors influencing computed tomography (CT) versus other imaging modalities.
Main Results:
- CT scans were the primary imaging modality in 50% of cases.
- Referring institutions utilized CT scans more frequently (78% vs. 46%).
- Children were 5.5 times more likely to undergo CT at referring facilities, independent of clinical factors.
Conclusions:
- Initial presentation at a referring hospital is a significant predictor for CT scan use in pediatric appendicitis.
- Clinical pathways are needed to standardize imaging and minimize radiation exposure.
- Increased access to pediatric abdominal ultrasound should be prioritized.
Purpose:
To evaluate trends and factors associated with interfacility differences in imaging modality selection in the diagnosis and management of children with suspected acute appendicitis.
Methods:
We conducted a retrospective review of diagnostic imaging selection and outcomes in patients <20 years of age who underwent appendectomy at a single Children's Hospital from June 2008 to June 2013. These results were then compared with those of referring hospitals.
Results:
A total of 232 children underwent appendectomy during the study period. Imaging results contributed to diagnostic and management decisions in 95.3 % of cases. CT scan was utilized as first-line imaging in 50 % of cases. CTs were preferentially performed at referring institutions (78 vs. 46 %, p < 0.001). Children were five times more likely to undergo CT at referring institutions (OR = 5.5, CI 3.0-10.2). Adjusting for demographics and Alvarado score, diagnostic imaging choice was independent of patient's clinical status.
Conclusion:
This study demonstrates that initial presentation to a referring hospital independently predicts the use of CT scan for suspected acute appendicitis. Further efforts should be undertaken to develop a clinical pathway that minimizes radiation exposure in the diagnosis of acute appendicitis, with focus on access to pediatric abdominal ultrasound.
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