Effect of Reduction in the Use of Computed Tomography on Clinical Outcomes of Appendicitis

Abstract

IMPORTANCE Advanced diagnostic imaging is commonly used in the evaluation of suspected appendicitis in children. Despite its inferior diagnostic performance, ultrasonography (US) is now preferred to computed tomography (CT) owing to concerns about ionizing radiation exposure. With changes in imaging modalities, the influence on outcomes should be assessed.OBJECTIVES To review trends in the use of US and CT for children with appendicitis and to investigate simultaneous changes in the proportions of negative appendectomy, appendiceal perforation, and emergency department (ED) revisits.

Abdominal ultrasonography of the pediatric gastrointestinal tract

“…Ultrasonography of the pediatric gastrointestinal tract can result in morbidity from an associated complication such as appendiceal rupture or bowel obstruction [53,54] . Non-operative management of acute uncomplicated appendicitis in children is also used in select cases [55,56] .…”

“…Symptoms of acute appendicitis are variable and can include periumbilical and/or right lower quadrant pain, anorexia, nausea, fever, and leukocytosis [54,57] . Ultrasound is the first imaging choice for suspected appendicitis at most centers [53,57] . Both grayscale and color Doppler imaging are utilized with 5-MHz curved, 9-MHz linear, or 15-MHz linear transducers [58] .…”

Campaigns Against Ionizing Radiation and Changed Practice Patterns for Imaging Use in Pediatric Appendicitis

“…2,3 How have the competing agendas of ensuring an accurate diagnosis while managing cost and patient risk affected physician practices regarding imaging for pediatric appendicitis? In this issue, Bachur et al 4 evaluate the changing trend of the use of imaging modalities in freestanding pediatric hospitals.…”

“…In their study, Bachur et al 4 performed a retrospective review of the trends in the use of US and CT for the diagnosis of pediatric appendicitis. Using the Pediatric Health Information System (PHIS) database managed by the Children’s Hospital Association, they examined 52 153 pediatric patients younger than 19 years with appendicitis and an encounter in the emergency department in 1 of 35 freestanding pediatric hospitals from 2010 through 2013.…”

“…Bachur et al 4 provide evidence that a decrease in CT and increase in US studies for the diagnosis of acute appendicitis at freestanding pediatric institutions has not resulted in a higher proportion of complications related to the potentially decreased sensitivity of US relative to CT. 1 The primary limitation of the data set is that 50% of children do not receive any imaging at the PHIS hospital of record. We cannot assume that these children underwent no imaging because observational studies that are designed to capture imaging use have found that more than 93%of children had preoperative imaging before appendectomy.…”