Decreased CT use for diagnosis of pediatric appendicitis associated with increased use of ultrasound: Study

A new study by Jack Scaife and team found that increased ultrasound (US) usage was associated with lower computed tomography (CT) use for diagnosing appendicitis. The findings of this study were published in the Journal of Surgical Research.

One of the most frequent causes of acute abdominal pain, the most prevalent ailment requiring abdominal surgery in children and the most frequent reason for emergency room physician lawsuits is acute appendicitis. An obstruction of the appendiceal lumen can cause acute appendicitis, which manifests as fluid retention, luminal distention, inflammation, and ultimately perforation. The typical symptoms of appendicitis are well-described, but, unusual presentations can occur in as many as one-third of individuals with acute appendicitis. To reduce radiation exposure, imaging guidelines advise evaluating appendicitis with ultrasound initially. It is yet unknown how US and computed tomography use are related. Thus, this study was to ascertain the relationship between the rate of CT examination of juvenile acute appendicitis and increasing US usage.

This study used the Nationwide Emergency Department Sample for 2019 and included patients with an appendicitis diagnosis who were less than 18 years old. Current Procedural Terminology codes were used to determine imaging. The definition of concurrent imaging was the use of CT and US at the same visit. Hospitals were classified into three tertiles based on the rate of concurrent imaging: low (< 20%), medium (20%–40%), and high (> 40%). With inverse probability weighting, an extended ordinal logistic regression model was created to evaluate hospital rates of concurrent imaging associations in relation to patient variables.

A total of 23,976 patients and 485 hospitals were included in this investigation. Hospitals in the lowest tertile served 34% of patients, followed by those in the middle (35%), and the highest tertile (31%). The growing US use was shown to be negatively correlated (−0.27, P < 0.001) with concurrent imaging utilization. Blacks and Hispanics had significantly lower chances of presenting to a hospital with a greater concurrent imaging rate when compared to Whites. Also, the patients in the lowest income quartile and second income quartile had greater chances of coming to a hospital with a higher concurrent imaging rate than patients in the highest income quartile. Overall, decreased use of CT for appendicitis diagnosis was connected with increased use of US. Children of color and the kids living in less affluent areas are more likely to attend hospitals that employ a lot of imaging simultaneously.

Source:

Scaife, J. H., Iantorno, S. E., & Bucher, B. T. (2024). Rates of Concurrent Computed Tomography Imaging Following Ultrasound for Pediatric Patients With Appendicitis. In Journal of Surgical Research (Vol. 302, pp. 134–143). Elsevier BV. https://doi.org/10.1016/j.jss.2024.06.048