Assessing the Role of Care Location in Imaging for Appendicitis: A Comparative Study

Area of Science:

• Pediatric Surgery
• Radiology
• Public Health

Background:

• Discrepancies in imaging for pediatric appendicitis evaluation contribute to unnecessary radiation exposure.
• This can lead to long-term health risks for children.
• Standardization efforts are needed to minimize radiation exposure.

Purpose of the Study:

• To evaluate differences in preoperative initial imaging for pediatric appendicitis based on patient presentation site.
• To identify opportunities for standardizing imaging practices and reducing radiation exposure.

Main Methods:

• Retrospective review of pediatric appendectomy patients (2022-2024) using the National Surgical Quality Improvement Program (NSQIP) database.
• Comparison of imaging modalities between patients initially evaluated at a Children's Hospital (CH) and those referred from Outside Hospitals (OSHs).

Main Results:

• CT utilization was significantly higher in OSH patients (63%) versus OSH-Sister (4%) and CH (2%).
• Ultrasound-only imaging was most common at CH (90%) compared to OSH-Sister (66%) and OSH (16%).
• CH maintained high ultrasound use for both uncomplicated (92%) and complicated (80%) appendicitis, while OSH had higher CT use for complicated cases (42%).

Conclusions:

• Significant discrepancies in imaging utilization, particularly CT scans, exist for pediatric appendicitis based on presentation site.
• Understanding referring facility practices is crucial for streamlining patient management.
• Prioritizing radiation stewardship standards is essential to mitigate risks from unnecessary radiation exposure in children.