F. O. Badru1, Y. Puckett1, N. Piening1, A. To1, P. Xu1, C. Fitzpatrick1, K. Chatoorgoon1, G. Villalona1, J. Greenspon1 1St. Louis University,Pediatric Surgery,St. Louis, MO, USA
Introduction:
Acute appendicitis (AA) is primarily a clinical diagnosis. Nonetheless, radiography is often used to aid the diagnosis with computed tomography (CT) imaging being the most common modality used at non-children’s hospitals. Radiation exposure is the reason for the decreased utilization of CT in pediatric centers (PC) as well as the development of low radiation dose protocols at PCs. We sought to compare the radiation dose exposure of CT imaging performed at outside hospitals (OH) versus PC in pediatric patients with AA.
Methods:
A retrospective review of all patients managed at our PC for AA from January 2011 to March 2016 was performed. Patients who had CT imaging for AA at OH were compared to those who underwent CT for appendicitis at our PC. Only patients who both received a CT scan and had dose information were included in this study. Demographic data, type of imaging used, location of imaging, CT dose used, use of intravenous contrast (IV) with CT were collected. Radiation dosing was compared using the dose index (CTDI [mGY]) and dose length product (DLP [mGYcm]). Independent samples t-test was used to compare means for radiation dose. Chi Square analysis was used to compare demographic data.
Results:
A total of 956 patients were treated for AA during the study period. A total of 379 patients met inclusion criteria, 59.6% of which were males. Mean age was 11.6 years and 64.6% were Caucasian. Mean duration of symptoms was 2.7 days. There were no difference between both groups demographically. There were 59.4% (225) patients treated primarily at our PC and 40.6% (154) patients were transferred from an OH. When performed at OH, 6.5% of CTs were considered non-diagnostic as they were done without IV contrast compared to 1.3% in our PC. Mean CTDI was 6.9 at our PC and 11.8 at OH ( p<0.0001). Mean DLP at PC was 296.2 versus 456.8 at OH ( p <0.0001). An excess radiation dose of 4.9 mGY and 160.5 mGYcm was noted when CT scan was performed at OH vs PC. Management of all patients were the same regardless of availability and type of imaging performed.
Conclusion:
Using DLP as a gauge of radiation exposure, CT imaging performed at OH has a 44% higher radiation rate relative to the exposure at PC. In cases of suspected AA at a facility without pediatric surgeons, early transfer to PC prior to imaging is advocated.