Ultrasound on par with CT for pediatric appendicitis: study

Last Updated: 2015-06-22

By Reuters Staff

NEW YORK (Reuters Health) - Campaigns against ionizing radiation exposure have led to a decrease in use of computed tomography (CT) and an increase in use of ultrasonography (US) in children with suspected acute appendicitis without harm, a new study suggests.

Increased reliance on "diagnostically inferior" ultrasound in the emergency department hasn't led to an increase in appendiceal perforation or repeat trips to the ED, the study team reported in JAMA Pediatrics online June 22.

Dr. Richard G. Bachur and colleagues from Boston Children's Hospital and Harvard Medical School in Massachusetts reviewed trends in the use of CT and US for appendicitis from 2010 to 2013 at 35 freestanding pediatric EDs. Using the Pediatric Health Information System (PHIS) database managed by the Children's Hospital Association, they analyzed a total of 52,153 children.

During the four-year study period, use of US increased 46% (from 24% in 2010 to 35% in 2013) and the use of CT decreased 48% (from about 21% to 12%). The proportion of negative appendectomies declined from about 5% in 2010 to 4% in 2013, with no change in perforations (32% in 2010 and 2013) and ED revisits (6% in both years).

With the known limitations of US, the researchers admit they had expected to see negative consequences, but to their "surprise" that wasn't the case.

They say the "unexpected" decrease in negative appendectomies cannot be fully understood from the administrative data they used, but may point to improvement in the diagnostic approach to children with suspected appendectomy. Future efforts should confirm these findings with patient-level data, they say.

The authors of an editorial say the primary limitation of the data set is that 50% of children do not receive any imaging at the PHIS hospital of record.

"We cannot assume that these children underwent no imaging," Dr. Morgan Richards of Seattle Children's Hospital and colleagues point out. "Instead, patients without imaging recorded at the PHIS institution more likely underwent imaging at the referring hospital, mostly likely a CT scan."

Nonetheless, they say this study and others suggest that the practice patterns of emergency medicine doctors and others involved in the care of children who present with acute abdominal pain has shifted.

The shift is "likely related to a collective consciousness regarding the potential risks of ionizing radiation and the increasing costs of health care," the authors write.

The increasing use of US and decreasing use of CT without a demonstrated rise in perforated appendicitis, missed appendicitis, or negative appendectomies "support the national message of avoiding the potentially harmful effects of ionizing radiation," Dr. Richards and colleagues conclude.

The authors reported no funding or disclosures. They did not respond to request for comment by press time.

SOURCE: http://bit.ly/1GCTGn5 and http://bit.ly/1K7s6lU

JAMA Pediatr 2015.