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

Background: Discrepancies in imaging utilization for pediatric appendicitis evaluation may lead to unnecessary radiation exposure and associated long-term health risks. This study evaluates differences in preoperative initial imaging based on the primary site of patient presentation to guide standardization efforts and minimize radiation exposure. Methods: A retrospective review of pediatric patients who underwent appendectomy at a single Children's Hospital (CH) between 2022 and 2024 was conducted using the National Surgical Quality Improvement Program (NSQIP) database. Imaging modalities were compared between patients initially evaluated at CH and those referred from outside hospitals (OSHs), including affiliated (OSH-Sister) and non-affiliated (OSH). Results: Of 339 patients, 49 (14%) presented from OSHs, 116 (34%) from OSH-Sister, and 174 (51%) were initially evaluated at CH. Overall, initial CT utilization was significantly higher among OSH patients (63%) compared to OSH-Sister (4%) and CH (2%) (P < .001). Ultrasound-only initial imaging was highest at CH (90%), compared to OSH-Sister (66%) and OSH (16%). In uncomplicated appendicitis, CH had the highest ultrasound utilization (92%) compared to OSH-Sister (67%) and OSH (14%) (P < .001). For complicated appendicitis, CH maintained high ultrasound use (80%), while CT use was highest at OSH (42%). Discussion: The observed discrepancies in radiation exposure, particularly in the use of CT scans, may have significant long-term health implications for pediatric patients. Understanding practices at referring facilities lends to the opportunity to streamline the management of patients. Implementation of radiation stewardship standards should be prioritized to mitigate potential risks associated with unnecessary radiation exposure in children.