Too many CT scans for pediatric appendicitis?

Last Updated: 2016-12-20

By Will Boggs MD

NEW YORK (Reuters Health) - Pediatric patients with appendicitis are far less likely to have preoperative CT scans at children's hospitals than at other types of hospitals, according to a new study.

"There needs to be active participation by practitioners to reduce radiation to children," said Dr. KuoJen Tsao from the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital.

"In order to reduce CT utilization, we need to find reasonable solutions to help make the diagnosis, such as increasing ultrasound use in non-children's hospitals," he told Reuters Health by email.

More than half of children with suspected appendicitis undergo some form of imaging, Dr. Tsao and colleagues write in Surgery, online December 2. But the choice is highly variable and dependent on clinician decision-making, as well as local availability and practices, they add.

The team investigated the use of preoperative imaging, especially CT, associated with pediatric appendicitis in a retrospective study of 1,448 patients, including 215 who first presented to the children's hospital and 1,233 who first presented to a non-children's hospital.

As the sole preoperative imaging modality, CT was used much more frequently at non-children's hospitals than at the children's hospital (70% vs. 23%, p<0.01).

In contrast, ultrasound was employed much more often as the only imaging at the children's hospital than at non-children's hospitals (75% vs. 20%, p<0.01).

"Pediatric patients are 7.6 times more likely to receive a CT if evaluated initially in non-children's hospitals," the researchers note. "Conversely, children presenting to the children's hospital were 11.7 times more likely to undergo ultrasound."

At the non-children's hospitals, ultrasound-only use ranged from 4% to 44%, and CT-only use ranged from 64% to 88% of patients.

On multivariable regression, age >=10 years, weight greater than 45 kg, and lack of insurance were significantly associated with CT use at non-children's hospitals, whereas Hispanic ethnicity was associated with lower odds of receiving a CT. Greater weight was associated with lesser rates of ultrasound and female patients were more likely to undergo ultrasound at these hospitals.

Younger children and Medicaid recipients were more likely to have ultrasound at the children's hospital.

"Future investigations will identify barriers and facilitators to decrease the use of CT in our hospital system as well as evaluate cost-effectiveness in a referral system model, with hopes of developing a guideline that would be applicable to other non-children's hospitals and similar institutional arrangements," the authors conclude.

The first step to reducing the use of CT in this setting, Dr. Tsao said, "is understanding or having an awareness of the scope of problem. For the individual practitioner, there probably isn't a good sense of scale of CT usage in the children."

SOURCE: http://bit.ly/2hQ8kUb

Surgery 2016.