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Pediatrics. 2013 Jan;131(1):e37-44. doi: 10.1542/peds.2012-1665. Epub 2012 Dec 24.

Use and accuracy of diagnostic imaging by hospital type in pediatric appendicitis.

Author information

1
Division of Pediatric Surgery, Washington University, One Children's Pl, Suite 5S40, St Louis, MO 63110 63110, USA. saitoj@wudosis.wustl.edu

Abstract

OBJECTIVE:

Accurate, timely diagnosis of pediatric appendicitis minimizes unnecessary operations and treatment delays. Preoperative abdominal-pelvic computed tomography (CT) scan is sensitive and specific for appendicitis; however, concerns regarding radiation exposure in children obligate scrutiny of CT use. Here, we characterize recent preoperative imaging use and accuracy among pediatric appendectomy subjects.

METHODS:

We retrospectively reviewed children who underwent operations for presumed appendicitis at a single tertiary-care children's hospital and examined preoperative CT and ultrasound use with subject characteristics. Preoperative imaging accuracy was compared with postoperative and histologic diagnosis as the reference standard.

RESULTS:

Most children (395/423, 93.4%) who underwent an operation for appendicitis during 2009-2010 had preoperative imaging. Final diagnoses included normal appendix (7.3%) and perforated appendicitis (23.6%). In multivariable analysis, initial evaluation at a community hospital versus the children's hospital was associated with 4.4-fold higher odds of obtaining a preoperative CT scan (P = .002), whereas preoperative ultrasound was less likely (odds ratio 0.20; P = .003). Ultrasound and CT sensitivities for appendicitis were diminished for studies performed at community hospitals compared with the children's hospital. Girls were 4.5-fold more likely to undergo both ultrasound and CT scans and were associated with lower ultrasound sensitivity for appendicitis.

CONCLUSIONS:

Widespread preoperative imaging did not eliminate unnecessary pediatric appendectomies. Controlling for factors potentially associated with referral bias, a CT scan was more likely to be performed in children initially evaluated at community hospitals compared with the children's hospital. Broadly-applicable strategies to systematically maximize diagnostic accuracy for childhood appendicitis, while minimizing ionizing radiation exposure, are urgently needed.

PMID:
23266930
PMCID:
PMC3529953
DOI:
10.1542/peds.2012-1665
[Indexed for MEDLINE]
Free PMC Article

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