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Children’s Hospitals Less Likely to Use CT Imaging for Appendicitis

HOUSTON – The likelihood of use of computed tomography (CT) imaging for appendicitis in pediatric patients varies based on whether treatment is being sought at a children’s hospital or a more general facility.

That’s according to a new study, published in the journal Surgery, which notes growing concerns about radiation exposure in children and recommendations to limit CT scans for appendicitis.

A study team from McGovern Medical School at The University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, both in Houston, posited that, within a metropolitan health system with one children’s hospital and eight non-children’s hospitals, the use of preoperative CT would be lower in the pediatric facility.

Their retrospective study of patients younger than 18 years of age undergoing appendectomy for acute appendicitis from April 2012 to April 2015 sought to determine whether their hypothesis was correct. Evaluated in the research were patient demographics, location, and imaging modality (CT and ultrasonography).

Results indicate that, with 1,488 pediatric patients included in the analysis, children's hospital patients had fewer CT scans – 23% vs. 70% – but more ultrasonography – 75% vs. 20%.

PDMR - Pediatric Emergency Medicine Reports-hz-v3

Increased preoperative CT use was significantly associated with non-children's hospitals, with an odds ratio of 7.6. At non-children's hospitals, older age, defined as 10 years and older, and higher patient weight, defined as greater than 45 kg, were predictors of CT use, according to the report.

At the same time, children presenting to a children's hospital were much more likely to undergo ultrasonography, with an odds ratio of 11.7.

“There are significant differences in imaging modalities for pediatric appendicitis between a children's hospital and non-children's hospitals,” study authors conclude. “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.”