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Negative Appendectomies: Evaluating Diagnostic Imaging Techniques at General versus Pediatric Emergency Departments
Andrew Shieh1, Phung K Pham2, Nicole A Plouffe3
1Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan; Department of Pediatrics, University of California at Irvine, Irvine, California.
The Journal of Emergency Medicine
|March 3, 2023
Summary
Pediatric appendicitis diagnosis can be challenging. This study found no significant difference in negative appendectomy rates between transferred and primary patients, suggesting ultrasound (US) may be valuable at adult facilities to reduce computed tomography (CT) use.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Emergency Medicine
Background:
- Appendicitis is a common pediatric surgical emergency with diagnostic challenges.
- Imaging modality use for appendicitis diagnosis varies significantly between institutions.
- Current diagnostic pathways lack standardization, impacting patient outcomes.
Purpose of the Study:
- To compare imaging practices and negative appendectomy rates in pediatric appendicitis patients.
- To evaluate differences between patients transferred from non-pediatric hospitals and those presenting directly.
- To assess the impact of imaging modalities on diagnostic accuracy.
Main Methods:
- Retrospective review of laparoscopic appendectomy cases in 2017.
- Comparison of imaging and histopathology results for transfer and primary patients.
- Statistical analysis using two-sample z-test and Fisher's exact test.
Main Results:
- No significant difference in negative appendectomy rates between transfer (6.5%) and primary (6.6%) patients.
- Ultrasound (US) was used less frequently in transferred patients (31%) compared to primary patients (82%).
- Negative appendectomy rates did not differ significantly between US performed at transfer hospitals versus the pediatric institution (11% vs. 5%).
Conclusions:
- Similar negative appendectomy rates exist despite differing imaging practices between facilities.
- Increased computed tomography (CT) use in non-pediatric facilities did not improve diagnostic accuracy.
- Promoting ultrasound utilization at adult facilities could potentially reduce CT use in pediatric appendicitis evaluation.
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