Diagnostic imaging varies in evaluation of patients with appendicitis at children's hospitals

A study published in the Academic Emergency Medicine (AEM) found variations across children’s hospitals in regards to diagnostic imaging when evaluating patients with appendicitis. These distinctions were due to the variations in hospital-level resources.

While many professional organizations recommend minimizing CT and instead using ultrasound as a first line of imaging for pediatric appendicitis, this was not the case in some hospitals.

Seven children’s hospitals were part of the retrospective investigation. Data from chart review of 160 consecutive patients diagnosed with appendicitis from each facility were compared with a survey of site medical directors regarding hospital resource availability, usual practices and departmental-level demographics. 

• A CT scan was performed first for 22.4 percent of patients, with a range across pediatric emergency departments of 3.1 to 83.8 percent.
• Ultrasound was performed for 54 percent of patients, with a range across pediatric emergency departments of 2.5 to 96.9 percent.

The only hospital-level factor significantly associated with ultrasound as the first imaging modality was 24-hour in-house availability.

Data suggest that the high cost to provide 24-hour staff for services such as ultrasonography technicians and qualified radiologists causes children to undergo CT scan for suspected appendicitis at night.

"This is a wonderful study that identifies potential harm to children when emergency departments are not provided with appropriate support. It highlights the need for emergency departments to have suitable resources to provide top quality care to all patients regardless of age or time of day," said James F. Holmes, MD, MPH, a professor and vice chair for research in the department of emergency medicine at the University of California, Davis School of Medicine, said in a statement.