R. Jones1, K. M. Gee1, S. Preston1, A. Beres1 1University of Texas Southwestern Medical Center,Division Of Pediatric Surgery, Department Of Surgery,Dallas, TX, USA
Introduction:
Diagnostic imaging in pediatric appendicitis may decrease rates of negative appendectomy and identify alternate pathologies. Many children with abdominal pain are initially evaluated at non-pediatric facilities, and subsequently transferred to dedicated pediatric centers for surgical management once a diagnosis of appendicitis is established. We compared imaging practices for children transferred from non-pediatric facilities versus directly admitted to our tertiary children’s hospital for appendicitis, and assessed the diagnostic accuracy in each population based upon final pathologic diagnosis.
Methods:
After IRB approval, we retrospectively reviewed all cases of laparoscopic appendectomy at our children’s hospital during 2015. Demographic and clinical data were collected, including age, transfer status, imaging studies performed, and diagnostic accuracy. Imaging studies included computed tomography (CT) and ultrasound. Diagnostic accuracy was defined by confirmed appendicitis on pathology report. Descriptive and comparative statistics were performed.
Results:
There were 1069 patients who underwent laparoscopic appendectomy for acute appendicitis during the study period. A large subset of our cohort was transferred from non-pediatric facilities (197 patients, 18.4%). Of transferred patients, 71.6% underwent preoperative CT scan, compared to 25.5% of non-transfer patients (p<0.000). Patients who presented directly were more likely to receive multiple imaging studies as compared to patients from outside centers (13.5% versus 5.1%, p=0.001). Of the additional studies performed in directly presenting patients, 91.5% were CT scans which were undertaken after inconclusive ultrasound. Rates of negative appendectomy were similar in non-transfer versus transferred patients (1.6% versus 2.0%, p=0.758). Logistic regression analysis revealed no combined influence initial study choice and transfer status on diagnostic accuracy (p=0.892)
Conclusion:
Our results show that non-pediatric facilities use CT more frequently to diagnose pediatric appendicitis. Contrastingly, CT is employed discriminately after nondiagnostic ultrasound at our tertiary pediatric center. The increased rate of CT use by adult centers does not confer diagnostic advantage as evidenced by equal rates of nontherapeutic surgery in each group. Transferring centers should strive to rely more heavily upon ultrasound, which may require education and development of improved pediatric ultrasound capacity.
