Abstract
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.
