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Lack of 24/7 Radiology Services Affects EDs’ Pediatric Appendicitis Evaluations

March 28th, 2017

FALL CHURCH, VA – Do children presenting with suspected appendicitis receive better care during daylight hours than at night?

A new study published ahead of print by Academic Emergency Medicine suggests that time of day might be a factor in how pediatric patients are treated.

Why? The study led by researchers from Inova Children’s Hospital in Falls Church suggests that variation in hospital resources can affect diagnostic evaluation of patients with appendicitis in children's hospitals. Among those issues are the high cost to provide around-the-clock staffing for optimal services, such as ultrasonography technicians and qualified radiologists.

That means children presenting at night are far more likely to receive a CT scan, with increased radiation exposure, for suspected appendicitis, study authors point out.

Conversely, availability of 24-hour, in-house ultrasound evaluations significantly increases the likelihood of ultrasound as first imaging and decreases CT scan use, according to the researchers, who recommend that hospitals seeking to increase the use of ultrasound should consider adding 24-hour in-house coverage.

The study team analyzed data from chart reviews of 160 consecutive patients 3 to 18 years old diagnosed with appendicitis from seven children’s hospitals, comparing its findings to a survey of site medical directors regarding hospital resource availability, usual practices, and departmental-level demographics.

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Results indicate that in the diagnostic evaluation of 1,090 children with appendicitis CT scan was performed first for 22.4% of patients, with a range across pediatric EDs of 3.1% to 83.8%. Ultrasound was performed first for 56.4% of patients with a range of 2.5% to 96.9%.

In the interest of limiting children’s exposure to ionizing radiation, guidelines from the American College of Emergency Physicians advises considering ultrasound as the initial imaging modality. The only hospital-level factor significantly associated with ultrasound as the first choice for imaging was 24-hour availability of in-house ultrasound, with an odds ratio of 29.2, according to the report.

Using ultrasound as the initial imaging instead of CT scan may reduce children’s exposure to radiation, and yet variations in hospitals’ resources may affect diagnostic evaluation of children with appendicitis, study authors conclude. Therefore, hospitals with a goal of increasing ultrasound as a first choice over CT should consider adding 24-hour in-house coverage for ultrasound imaging, the authors note.

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