Elsevier

Journal of Pediatric Surgery

Volume 40, Issue 12, December 2005, Pages 1908-1911
Journal of Pediatric Surgery

The influence of advanced radiographic imaging on the treatment of pediatric appendicitis

https://doi.org/10.1016/j.jpedsurg.2005.08.004Get rights and content

Abstract

Purpose

Since 1998, the use of advanced radiographic imaging with computed tomography (CT) and/or diagnostic ultrasound (US) has increased dramatically for the diagnosis of acute appendicitis in children. This study investigates the impact of this imaging on the evaluation, management, and outcome of pediatric patients who underwent appendectomy for suspected appendicitis.

Methods

Retrospective review of 197 consecutive children with a preoperative diagnosis of acute appendicitis, from January 2002 through May 2004, undergoing appendectomy at a university-affiliated community hospital by pediatric and general surgeons.

Results

Patients were divided into two groups: imaged (n = 106; 54%) and nonimaged (n = 91; 46%). Groups were similar with respect to age, sex, temperature, white blood count, and insurance status. Ninety-seven imaged patients had CT, 6 had US, and 3 had both CT and US. Seventy-one percent of imaging studies were ordered by emergency department physicians and 24% by treating surgeons. Average wait from emergency department triage to operative incision for the imaged and nonimaged groups was 12.1 and 5.4 hours, respectively (P < .0001). Both groups had similar perforation rates (imaged: 15.1%, nonimaged: 14.6%). Negative appendectomy rates were 10.4% (imaged) and 4.4% (nonimaged). Average hospital charges were $11,791 (imaged) and $9360 (nonimaged) (P = .001). Time on antibiotics, complication rates, and length of stay were similar for both groups.

Conclusions

More than half of pediatric patients with suspected appendicitis now undergo advanced imaging and experience a significant delay in surgical treatment with a 26% increase in hospital charges and no clear-cut improvement in diagnostic accuracy nor outcome, when compared with evaluation by the treating surgeons.

Section snippets

Materials and methods

A retrospective review of medical records of 197 consecutive children with a preoperative diagnosis of acute appendicitis from January 2002 through May 2004 was completed following institutional review board approval. Demographic data including sex, age, and insurance status were collected as well as variables corresponding to preoperative evaluation, management, and postoperative outcomes. Variables included white blood cell (WBC) count, highest preoperative temperature, preoperative imaging

Results

From January 2002 through May 2004, there were 197 pediatric appendectomies performed for a preoperative diagnosis of acute appendicitis. The mean age for the group was 10.5 years (range, 2-17 years). There were 75 females (38%) and 122 males (62%).

Imaging studies were performed in 106 (54%) patients (group A) (Table 1). Ninety-one (46%) patients did not receive an imaging study (group B). There was no significant difference in the sex of the patient with regard to who received an imaging

Discussion

The use of advanced imaging studies for the diagnosis of suspected acute appendicitis in children appears to be routine in some institutions, although others argue for its use only in selective cases, mostly using it in females and equivocal cases [6], [7], [8], [12], [13]. In a recent survey of 344 members of the American Pediatric Surgical Association, 19.8% of respondents report the frequent use of imaging (>67% of cases) for the preoperative evaluation of appendicitis [14]. Although US was

Acknowledgments

The authors thank Gary Koch, PhD, for statistical analysis assistance. DY thanks the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health for a short-term research training grant.

References (18)

There are more references available in the full text version of this article.

Cited by (38)

  • Diagnostic performance of emergency physician-performed point-of-care ultrasonography for acute appendicitis: A meta-analysis

    2019, American Journal of Emergency Medicine
    Citation Excerpt :

    These characteristics can improve decision-making, shorten ED stays, improve prognosis, lower costs, and reduce the cumulative radiation dose. The second attribute is the inclusion of a subgroup analysis for pediatric AA, as these patients are more vulnerable to radiation hazards than adults [53], and approximately 60% of American children who are diagnosed with acute appendicitis undergo preoperative CT [54, 55]. Although the small number of studies (n = 7) that included pediatric patients may limit the interpretation of our findings, the diagnostic performance in pediatric studies was higher than that in studies of adults.

  • Is pelvic ultrasound associated with an increased time to appendectomy in Pediatric Appendicitis?

    2014, Journal of Emergency Medicine
    Citation Excerpt :

    Similarly, in a retrospective review of 197 children with suspected appendicitis, York et al. found a significantly increased time from ED triage to incision in patients who underwent either US or CT imaging (12.1 h) compared with those who did not (5.4 h). There were no differences in diagnostic accuracy or outcomes between imaged and nonimaged patients (15). Garfield et al. retrospectively studied 124 adult and pediatric patients who underwent operative exploration for presumed appendicitis in a teaching hospital (34).

  • Advanced radiologic imaging for pediatric appendicitis, 2005-2009: Trends and outcomes

    2012, Journal of Pediatrics
    Citation Excerpt :

    When CT was introduced as a diagnostic tool for appendicitis in children, its great diagnostic sensitivity obviated the need for routine admission of patients with equivocal findings for serial examinations.1,32 In addition, CT was expected to identify early cases of appendicitis and thereby reduce the rate of perforation; this decreased rate was inconsistently appreciated in previous investigations and was not associated with CT rates in the present study.33-38 However, our data continue to support the inverse association between diagnostic imaging and lower negative appendectomy rates.9,34-39

View all citing articles on Scopus

Presented at the 38th Annual Meeting of the Pacific Association of Pediatric Surgeons, May 22-26, 2005, Vancouver, Canada.

View full text