Imaging gently? Higher rates of computed tomography imaging for pediatric appendicitis in non-children's hospitals

Abstract

Background: Growing concerns regarding radiation exposure in children have led to recommendations to minimize computed tomography imaging for appendicitis. We hypothesized that within a metropolitan hospital system (1 children's hospital and 8 non-children's hospitals), use of preoperative computed tomography is much greater in non-children's hospitals.

Methods: We conducted a retrospective study of patients <18 years of age undergoing appendectomy for acute appendicitis from April 2012 to April 2015. Patient demographics, location, and imaging modality (computed tomography and ultrasonography) were evaluated.

Results: A total of 1,448 pediatric patients were identified (children's hospital = 215, 15%; non-children's hospitals = 1,233, 85%). Children's hospital patients had fewer computed tomography scans (23% vs 70%, P < .01) and more ultrasonography (75% vs 20%, P < .01). On multivariate regression, increased preoperative computed tomography use was significantly associated with non-children's hospitals (odds ratio 7.6, 95% confidence interval 5.4-10.8). At non-children's hospitals, older age (age >10: odds ratio 2.4, 95% confidence interval 1.8-3.1) and higher patient weight (>45 kg odds ratio 2.0, 95% confidence interval 1.4-2.8) predicted computed tomography use. Children presenting at a children's hospital were much more likely to undergo ultrasonography (odds ratio 11.7, 95% confidence interval 8.3-16.6).

Conclusion: There are significant differences in imaging modalities for pediatric appendicitis between a children's hospital and non-children's hospitals. Further investigation is needed to identify other factors contributing to imaging preference in the pediatric population in order to establish clinical practice guidelines to decrease or prevent unnecessary radiation exposure in children.