Monday, December 24, 2012 05:36 PM

Use and Accuracy of Diagnostic Imaging by Hospital Type in Pediatric Appendicitis

Because pediatric appendicitis is challenging to diagnose, computed tomography (CT) is used frequently. Childhood radiation exposure is associated with increased risk of cancer. Ultrasound avoids radiation exposure but is less sensitive for appendicitis than CT. 

Controlling for referral bias, evaluation at a community compared with a children’s hospital is associated with higher CT and lower ultrasound use before appendectomy. CT and ultrasound accuracy for appendicitis in children varies with hospital type.

Accounting for 84 000 hospitalizations per year in the United States, appendicitis is the most common surgically-treated cause of pediatric acute abdominal pain. Because of nonspecific symptoms, examination findings, and laboratory abnormalities, the definitive diagnosis poses many challenges, especially in young children. Several nonsurgical conditions, such as gastroenteritis, urinary tract infection, pneumonia, and ovarian pathology, can mimic appendicitis. Such diagnostic difficulty contributes to the occurrence of “negative” appendectomy, or finding a normal appendix during operation, in 3.7% to 13% of cases. Expeditious diagnosis of appendicitis is a priority, because prolonged appendiceal inflammation progresses to gangrene or perforation, which is associated with lengthy recovery and greater risk of complications.

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Copyright © 2013 by the American Academy of Pediatrics