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J Pediatr Surg. 2015 Apr;50(4):642-6. doi: 10.1016/j.jpedsurg.2014.09.080. Epub 2014 Dec 6.

Use and accuracy of diagnostic imaging in the evaluation of pediatric appendicitis.

Author information

1
Department of Surgery, University of Washington, Seattle, WA, USA; Surgical Outcomes Research Center (SORCE), University of Washington, Seattle, WA, USA; CHASE Alliance, University of Washington, Seattle, WA, USA. Electronic address: mkotagal@uw.edu.
2
Department of Surgery, University of Washington, Seattle, WA, USA; Department of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA.
3
Department of Surgery, University of Washington, Seattle, WA, USA; Surgical Outcomes Research Center (SORCE), University of Washington, Seattle, WA, USA; CHASE Alliance, University of Washington, Seattle, WA, USA.
4
Department of General and Thoracic Surgery, Mary Bridge Children's Hospital, Tacoma, WA, USA.
5
Department of Pediatric Surgery, Swedish Medical Center, Seattle, WA, USA.
6
Department of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA.

Abstract

BACKGROUND:

There are safety concerns about the use of radiation-based imaging (computed tomography [CT]) to diagnose appendicitis in children. Factors associated with CT use remain to be determined.

METHODS:

For patients ≤18 years old undergoing appendectomy, we evaluated diagnostic imaging performed, patient characteristics, hospital type, and imaging/pathology concordance (2008-2012) using data from Washington State's Surgical Care and Outcomes Assessment Program.

RESULTS:

Among 2538 children, 99.7% underwent pre-operative imaging. 52.7% had a CT scan as their first study. After adjustment, age >10 years (OR 2.9 (95% CI 2.2-4.0), Hispanic ethnicity (OR 1.7, 95% CI 1.5-1.9), and being obese (OR 1.7, 95% CI 1.4-2.1) were associated with CT use first. Evaluation at a non-children's hospital was associated with higher odds of CT use (OR 7.9, 95% CI 7.5-8.4). Ultrasound concordance with pathology was higher for males (72.3 vs. 66.4%, p=.03), in perforated appendicitis (75.9 vs. 67.5%, p=.009), and at children's hospitals compared to general adult hospitals (77.3 vs. 62.2%, p<.001). CT use has decreased yearly statewide.

CONCLUSIONS:

Over 50% of children with appendicitis had radiation-based imaging. Understanding factors associated with CT use should allow for more specific QI interventions to reduce radiation exposure. Site of care remains a significant factor in radiation exposure for children.

KEYWORDS:

Appendicitis; Patient safety; Surgery

PMID:
25840079
PMCID:
PMC4385196
DOI:
10.1016/j.jpedsurg.2014.09.080
[Indexed for MEDLINE]
Free PMC Article

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