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Diagnostic imaging for acute appendicitis: interfacility differences in practice patterns

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Abstract

Purpose

To evaluate trends and factors associated with interfacility differences in imaging modality selection in the diagnosis and management of children with suspected acute appendicitis.

Methods

We conducted a retrospective review of diagnostic imaging selection and outcomes in patients <20 years of age who underwent appendectomy at a single Children’s Hospital from June 2008 to June 2013. These results were then compared with those of referring hospitals.

Results

A total of 232 children underwent appendectomy during the study period. Imaging results contributed to diagnostic and management decisions in 95.3 % of cases. CT scan was utilized as first-line imaging in 50 % of cases. CTs were preferentially performed at referring institutions (78 vs. 46 %, p < 0.001). Children were five times more likely to undergo CT at referring institutions (OR = 5.5, CI 3.0–10.2). Adjusting for demographics and Alvarado score, diagnostic imaging choice was independent of patient’s clinical status.

Conclusion

This study demonstrates that initial presentation to a referring hospital independently predicts the use of CT scan for suspected acute appendicitis. Further efforts should be undertaken to develop a clinical pathway that minimizes radiation exposure in the diagnosis of acute appendicitis, with focus on access to pediatric abdominal ultrasound.

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Conflict of interest

The authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Maria Michailidou, Maria G. Sacco Casamassima, Omar Karim, Colin Gause, Jose H. Salazar, Seth D. Goldstein & Fizan Abdullah

  2. Bloomberg Children’s Center, Johns Hopkins University School of Medicine, # 7351, Baltimore, MD, 21287, USA

    Fizan Abdullah

Authors
  1. Maria Michailidou
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  2. Maria G. Sacco Casamassima
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  3. Omar Karim
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  4. Colin Gause
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  5. Jose H. Salazar
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  6. Seth D. Goldstein
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  7. Fizan Abdullah
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Correspondence to Fizan Abdullah.

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Michailidou, M., Sacco Casamassima, M.G., Karim, O. et al. Diagnostic imaging for acute appendicitis: interfacility differences in practice patterns. Pediatr Surg Int 31, 355–361 (2015). https://doi.org/10.1007/s00383-015-3669-0

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  • DOI: https://doi.org/10.1007/s00383-015-3669-0

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