Related Experiment Video
Updated: Feb 8, 2026
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Hospital type predicts computed tomography use for pediatric appendicitis
Kathryn Tinsley Anderson1, Marisa A Bartz-Kurycki1, Mary T Austin2
1McGovern Medical School, University of Texas Health Sciences Center at Houston, Department of Pediatric Surgery, Houston, TX; Center for Surgical Trials and Evidence-Based Practice (C-STEP), Houston, TX.
Insights
Pediatric appendicitis imaging guidelines favor ultrasound (US) over computed tomography (CT). Presentation at non-children's hospitals strongly predicts CT use, leading to unnecessary radiation exposure in children.
Area of Science:
- Pediatric surgery
- Radiology
- Medical imaging
Background:
- Guidelines recommend ultrasound (US) over computed tomography (CT) for pediatric appendicitis.
- High CT use in children leads to unnecessary radiation exposure.
- Study evaluates factors influencing preoperative CT use in pediatric appendectomy patients.
Purpose of the Study:
- To identify variables associated with preoperative computed tomography (CT) use in pediatric appendectomy patients.
- To analyze imaging practices and trends in pediatric appendicitis care.
- To understand the impact of hospital type on imaging modality selection.
Main Methods:
- Retrospective cohort study of 22,333 pediatric patients undergoing appendectomy (2015-2016).
- Evaluated variables: age, BMI, race/ethnicity, gender, and hospital type (NSQIP-P vs. non-NSQIP-P).
- Primary outcome: preoperative CT receipt; secondary outcomes: reimaging, trends over time.
Main Results:
- Ultrasound (US) was the most common initial imaging (52%), followed by CT only (27%).
- Older age, obesity, female gender, and non-NSQIP-P hospital presentation increased CT odds.
- Presentation at a non-NSQIP-P hospital was the strongest predictor of CT use (OR 9.4).
Conclusions:
- Hospital presentation, particularly at non-children's hospitals, is the primary driver of CT use in pediatric appendicitis.
- National Surgical Quality Improvement Program for Pediatrics (NSQIP-P) hospitals frequently reimage transferred patients and have not reduced CT use.
- Novel strategies are needed to reduce unnecessary CT imaging across all hospital types.
Background:
Evidence-based guidelines recommend ultrasound (US) over computed tomography (CT) as the primary imaging modality for suspected pediatric appendicitis. Continued high rates of CT use may result in significant unnecessary radiation exposure in children. The purpose of this study was to evaluate variables associated with preoperative CT use in pediatric appendectomy patients.
Methods:
A retrospective cohort study of pediatric patients who underwent appendectomy for acute appendicitis in 2015-2016 at National Surgical Quality Improvement Program for Pediatrics (NSQIP-P) hospitals was conducted. Pediatric (<18 years old) patients who underwent appendectomy for acute appendicitis in an NSQIP-P hospital from 2015 to 2016 were included. Patients were excluded if they underwent interval or incidental appendectomy or did not have a final diagnosis of appendicitis. Variables associated with imaging evaluation, including age, body mass index (BMI), race/ethnicity, gender and hospital of presentation (NSQIP-P vs. non-NSQIP-P hospital) were evaluated. The primary outcome was receipt of preoperative CT. Secondary outcomes include reimaging practices and trends over time.
Results:
22,333 children underwent appendectomies, of which almost all were imaged preoperatively (96.5%) and 36% of whom presented initially to a non-NSQIP-P hospital. Overall, US only was the most common imaging modality (52%), followed by CT only (27%), US+CT (16%), no imaging (3%), MRI +/- CT/US (1%) and MRI only (<1%). On regression, older age (>11 years), obesity (BMI >95th percentile for age), and female gender were associated with increased odds of receiving a CT scan. However, initial presentation to a non-NSQIP-P hospital was the strongest predictor of CT use (OR 9.4, 95% CI 8.1-10.8). Reimaging after transfer was common, especially after US and MRI at a non-NSQIP-P hospital. CT use decreased between 2015 and 2016 in non-NSQIP-P hospitals but remained the same (25%) in NSQIP-P facilities.
Conclusions:
Though patient characteristics were associated with different imaging practices, presentation at a referral, nonchildren's hospital is the strongest predictor of CT use in children with appendicitis. NSQIP-P hospitals frequently reimage transferred patients and have not reduced their CT use. Novel strategies are required for all hospital types in order to sustain reduction in CT use and mitigate unnecessary imaging.
Level Of Evidence:
Level III.
Type Of Study:
Retrospective comparative study.
Related Concept Videos
01:10Computed Tomography
The technique was invented in the 1970s and is based on the principle that as X-rays pass through the body, they are absorbed or reflected at different levels. In the technique, a patient lies on a motorized platform while a computerized axial tomography (CAT) scanner rotates...
00:59Hospitals-II
Nurses that work in...
01:28Hospitals-I
01:27Imaging Studies III: Computed Tomography
01:22Appendicitis-I: Introduction
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...