Since 1998, the use of advanced radiographic imaging with computed tomography and/or diagnostic ultrasound has increased dramatically for the diagnosis of acute appendicitis in children.
Dr Phillips and colleagues investigated the impact of this imaging on the outcome for pediatric appendicitis.
The investigators assessed the impact of the imaging on the evaluation, management, and outcome of appendectomy for suspected appendicitis.
The investigative team conducted a retrospective review from 2002 to 2004 of 197 consecutive children with a preoperative diagnosis of acute appendicitis.
The patients underwent appendectomy at a university-affiliated community hospital by pediatric and general surgeons.
| Negative appendectomy rates were 10% in the imaged group vs 4% in the nonimaged group|
|Journal of Pediatric Surgery|
Patients were divided into 2 groups, of which 106 were imaged, and 91 were nonimaged.
Groups were similar with respect to age, sex, temperature, white blood count, and insurance status.
The team reported that 97 imaged patients had computed tomography, 6 had diagnostic ultrasound, and 3 had both imaging techniques.
A further 71% 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 and 5 hours, respectively.
The investigators observed that both groups had similar perforation rates, and were 15%.
Negative appendectomy rates were 10% in the imaged group and 4% in the nonimaged group.
The team found that the average hospital charges were $11,791 in the imaged, and $9360 in the nonimaged group.
Time on antibiotics, complication rates, and length of stay were similar for both groups.
Dr Phillips' team concluded, “More than half of pediatric patients with suspected appendicitis now undergo advanced imaging and experience a significant delay in surgical treatment.”
“There is a 26% increase in hospital charges and no clear-cut improvement in diagnostic accuracy nor outcome, when compared with evaluation by the treating surgeons.”