Association of Hospital Resources and Imaging Choice for Appendicitis in Pediatric Emergency Departments

Abstract

Objective

Abdominal pain and concern for appendicitis are common chief complaints in patients presenting to the pediatric emergency department (PED)¹. Although many professional organizations recommend decreasing use of CT and choosing ultrasound as first line imaging for pediatric appendicitis, significant variability persists in imaging utilization^2,3,4.

This study investigated practice variation across children's hospitals in the diagnostic imaging evaluation of appendicitis and determined hospital-level characteristics associated with the likelihood of ultrasound as the first imaging modality.

Methods

This was a multicenter (seven children's hospitals) retrospective investigation. Data from chart review of 160 consecutive patients aged 3-18 years diagnosed with appendicitis from each site was compared with a survey of site medical directors regarding hospital resource availability, usual practices, and departmental level demographics.

Results

In the diagnostic evaluation of 1090 children with appendicitis, CT scan was performed first for 22.4% of patients, with a range across PEDs of 3.1-83.8%. Ultrasound was performed for 54.0% of patients with a range of 2.5-96.9%. The only hospital level factor significantly associated with ultrasound as the first imaging modality was 24-hour availability of in-house ultrasound (OR 29.2, 95% CI 1.2-691.8).

Conclusion

Across children's hospitals, significant practice variation exists regarding diagnostic imaging in the evaluation of patients with appendicitis. Variation in hospital level resources may impact the diagnostic evaluation of patients with appendicitis. Availability of 24-hour in house ultrasound significantly increases the likelihood of ultrasound as first imaging and decreases CT scans. Hospitals aiming to increase the use of ultrasound should consider adding 24-hour in house coverage.

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