Meera Kotagal1, Morgan K Richards2, David R Flum3, Stephanie P Acierno4, Robert L Weinsheimer5, Adam B Goldin6. 1. Department of Surgery, University of Washington, Seattle, WA, USA; Surgical Outcomes Research Center (SORCE), University of Washington, Seattle, WA, USA; CHASE Alliance, University of Washington, Seattle, WA, USA. Electronic address: mkotagal@uw.edu. 2. Department of Surgery, University of Washington, Seattle, WA, USA; Department of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA. 3. Department of Surgery, University of Washington, Seattle, WA, USA; Surgical Outcomes Research Center (SORCE), University of Washington, Seattle, WA, USA; CHASE Alliance, University of Washington, Seattle, WA, USA. 4. Department of General and Thoracic Surgery, Mary Bridge Children's Hospital, Tacoma, WA, USA. 5. Department of Pediatric Surgery, Swedish Medical Center, Seattle, WA, USA. 6. Department of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA.
Abstract
BACKGROUND: There are safety concerns about the use of radiation-based imaging (computed tomography [CT]) to diagnose appendicitis in children. Factors associated with CT use remain to be determined. METHODS: For patients ≤18 years old undergoing appendectomy, we evaluated diagnostic imaging performed, patient characteristics, hospital type, and imaging/pathology concordance (2008-2012) using data from Washington State's Surgical Care and Outcomes Assessment Program. RESULTS: Among 2538 children, 99.7% underwent pre-operative imaging. 52.7% had a CT scan as their first study. After adjustment, age >10 years (OR 2.9 (95% CI 2.2-4.0), Hispanic ethnicity (OR 1.7, 95% CI 1.5-1.9), and being obese (OR 1.7, 95% CI 1.4-2.1) were associated with CT use first. Evaluation at a non-children's hospital was associated with higher odds of CT use (OR 7.9, 95% CI 7.5-8.4). Ultrasound concordance with pathology was higher for males (72.3 vs. 66.4%, p=.03), in perforated appendicitis (75.9 vs. 67.5%, p=.009), and at children's hospitals compared to general adult hospitals (77.3 vs. 62.2%, p<.001). CT use has decreased yearly statewide. CONCLUSIONS: Over 50% of children with appendicitis had radiation-based imaging. Understanding factors associated with CT use should allow for more specific QI interventions to reduce radiation exposure. Site of care remains a significant factor in radiation exposure for children.
BACKGROUND: There are safety concerns about the use of radiation-based imaging (computed tomography [CT]) to diagnose appendicitis in children. Factors associated with CT use remain to be determined. METHODS: For patients ≤18 years old undergoing appendectomy, we evaluated diagnostic imaging performed, patient characteristics, hospital type, and imaging/pathology concordance (2008-2012) using data from Washington State's Surgical Care and Outcomes Assessment Program. RESULTS: Among 2538 children, 99.7% underwent pre-operative imaging. 52.7% had a CT scan as their first study. After adjustment, age >10 years (OR 2.9 (95% CI 2.2-4.0), Hispanic ethnicity (OR 1.7, 95% CI 1.5-1.9), and being obese (OR 1.7, 95% CI 1.4-2.1) were associated with CT use first. Evaluation at a non-children's hospital was associated with higher odds of CT use (OR 7.9, 95% CI 7.5-8.4). Ultrasound concordance with pathology was higher for males (72.3 vs. 66.4%, p=.03), in perforated appendicitis (75.9 vs. 67.5%, p=.009), and at children's hospitals compared to general adult hospitals (77.3 vs. 62.2%, p<.001). CT use has decreased yearly statewide. CONCLUSIONS: Over 50% of children with appendicitis had radiation-based imaging. Understanding factors associated with CT use should allow for more specific QI interventions to reduce radiation exposure. Site of care remains a significant factor in radiation exposure for children.
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