Diagnostic imaging for acute appendicitis: interfacility differences in practice patterns

被引:10
作者
Michailidou, Maria [1 ]
Casamassima, Maria G. Sacco [1 ]
Karim, Omar [1 ]
Gause, Colin [1 ]
Salazar, Jose H. [1 ]
Goldstein, Seth D. [1 ]
Abdullah, Fizan [1 ,2 ]
机构
[1] Johns Hopkins Univ, Sch Med, Ctr Pediat Surg Clin Trials & Outcomes Res, Div Pediat Surg, Baltimore, MD 21287 USA
[2] Johns Hopkins Univ, Sch Med, Bloomberg Childrens Ctr, Baltimore, MD 21287 USA
关键词
Appendicitis; Ultrasonography; Computed tomography; Imaging choice; Pediatric; PEDIATRIC EMERGENCY-DEPARTMENT; COMPUTED-TOMOGRAPHY; RADIATION-EXPOSURE; SUSPECTED APPENDICITIS; ABDOMINAL-PAIN; CHILDREN; ULTRASOUND; SCORE; US; APPENDECTOMY;
D O I
10.1007/s00383-015-3669-0
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
To evaluate trends and factors associated with interfacility differences in imaging modality selection in the diagnosis and management of children with suspected acute appendicitis. We conducted a retrospective review of diagnostic imaging selection and outcomes in patients < 20 years of age who underwent appendectomy at a single Children's Hospital from June 2008 to June 2013. These results were then compared with those of referring hospitals. A total of 232 children underwent appendectomy during the study period. Imaging results contributed to diagnostic and management decisions in 95.3 % of cases. CT scan was utilized as first-line imaging in 50 % of cases. CTs were preferentially performed at referring institutions (78 vs. 46 %, p < 0.001). Children were five times more likely to undergo CT at referring institutions (OR = 5.5, CI 3.0-10.2). Adjusting for demographics and Alvarado score, diagnostic imaging choice was independent of patient's clinical status. This study demonstrates that initial presentation to a referring hospital independently predicts the use of CT scan for suspected acute appendicitis. Further efforts should be undertaken to develop a clinical pathway that minimizes radiation exposure in the diagnosis of acute appendicitis, with focus on access to pediatric abdominal ultrasound.
引用
收藏
页码:355 / 361
页数:7
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