Imaging Widely Used in Presumed Pediatric Appendicitis

Children evaluated at community, not children's, hospital more likely to have preop CT scan

THURDAY, Dec. 27 (HealthDay News) -- Most children with presumed appendicitis undergo preoperative computed tomography (CT) and ultrasound imaging before surgery, with significant variation by hospital type and patient sex, according to research published online Dec. 24 in Pediatrics.

To characterize preoperative CT and ultrasound use among pediatric appendectomy subjects, Jacqueline M. Saito, M.D., of Washington University School of Medicine in St. Louis, and colleagues conducted a retrospective study involving 423 children who underwent surgery for presumed appendicitis at a single tertiary care children's hospital.

The researchers found that 93.4 percent of those who underwent surgery for presumed appendicitis had preoperative imaging. Overall, 7.3 percent were ultimately diagnosed as normal appendix and 23.6 percent were diagnosed with perforated appendicitis. Those who were initially evaluated at a community hospital were 4.4-fold more likely to be imaged with CT and less likely to receive preoperative ultrasound (odds ratio, 0.20). The sensitivities of both CT and ultrasound scans for appendicitis were reduced when performed in community versus the children's hospital. Girls were 4.5-fold more likely to undergo ultrasound and CT scans, and had lower ultrasound sensitivity for appendicitis.

"Potential targets to streamline the evaluation for pediatric appendicitis include algorithm development with broad validity to decrease reliance on preoperative imaging and radiation exposure while avoiding unnecessary hospital transfers, admissions, operations, and missed diagnoses," the authors write.

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