Are We Doing Enough to Reduce Ionizing Radiation Exposure in Children?: An Analysis of Current Approaches to Pediatric Appendicitis Imaging at a Major Urban Medical Center

Area of Science:

• Pediatric Emergency Medicine
• Diagnostic Imaging
• Gastrointestinal Disorders

Background:

• Appendicitis (AP) is a common surgical emergency in children.
• Accurate and timely diagnosis is crucial for effective treatment and preventing complications.
• Current imaging modalities in pediatric emergency departments (EDs) warrant evaluation for optimization.

Purpose of the Study:

• To assess the utilization and effectiveness of current imaging techniques for suspected appendicitis (AP) in a pediatric emergency department (ED).
• To identify patterns in imaging choices, diagnostic accuracy, and patient outcomes.
• To inform future strategies for improving diagnostic imaging in pediatric AP cases.

Main Methods:

• Retrospective review of charts for children aged 6-18 years presenting with suspected AP in 2016.
• Data collected included patient demographics, timing of evaluation, imaging studies performed (ultrasound, CT, MRI), results, and patient disposition.
• Statistical analysis of imaging modality usage, diagnostic yield, and clinical outcomes.

Main Results:

• Of 292 children with suspected AP, ultrasound was the most common initial imaging study (287), with 60.3% yielding equivocal results.
• Computed tomography (CT) scans were performed in 13.9% of patients, and magnetic resonance imaging (MRI) in 0.7%.
• The overall appendicitis (AP) rate was 28.4%, with 97.5% of appendectomies confirming abnormal appendices.

Conclusions:

• Computed tomography (CT) scans were utilized in a significant portion of pediatric suspected appendicitis cases.
• The high rate of equivocal ultrasound findings highlights a potential area for improvement in diagnostic accuracy.
• Future strategies should explore increased use of MRI and other advanced imaging modalities to potentially reduce reliance on CT scans and improve diagnostic yield.