CT use for children with appendicitis more prevalent in community hospitals

Children who are brought to general hospitals with suspected appendicitis are more likely than those brought to children's hospitals to undergo CT imaging, according to a study recently published in the journal Pediatrics.

In the study, Jacqueline Saito, assistant professor of surgery at the Washington University School of Medicine in St. Louis, and colleagues analyzed the records of 423 children who underwent appendix removal surgery. Of those children, 218 initially were evaluated at St. Louis Children's Hospital, and 205 at general hospitals.

The researchers found that about 85 percent of the children evaluated at a general hospital underwent CT scans, while just 45 percent of children at Children's Hospital underwent CT scans. However, more than half of the children seen at Children's were scanned with ultrasound, compared to 20 percent at general hospitals.

There is growing concern about the increasing use of CT to evaluate abdominal pain in children. Last fall, a study that relied upon statistics from the National Hospital Ambulatory Medical Care Survey found that between 1998 and 2008, CT use to evaluate abdominal pain in children grew from 0.9 percent to 15.4 percent, even though there were no changes in ultrasound, radiograph use, diagnosis of appendicitis or hospital admission.

Saito pointed out that while ultrasound may be a preferred method of diagnosing appendicitis in children because it doesn't expose them to radiation, personnel with specialized training who are familiar with pediatric diagnostics must perform the procedure.

"Ultrasound scans are difficult to perform correctly in this context, and what specialists can do at Children's Hospital may not be realistic or even available in a general hospital, which doesn't care for children as often," Saito said in an announcement.

As a follow-up, Saito is looking into the outcomes of patients who underwent scans that ruled out appendectomies. "Ultimately what we'd liked to do is learn how we can reduce our use of CT imaging without compromising patient care," she said. "We want to find ways to identify the patients who really need these scans and those who can be effectively evaluated using other methods."

For more:
- see the study abstract
- see the announcement from Washington University

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