title: Increasing computed tomography use for patients with appendicitis and discrepancies in pain management between adults and children: an analysis of the NHAMCS.
abstract: OBJECTIVE
  Using a national sample of emergency department (ED) visits, we aim to describe use of CBC, computed tomography (CT), and pain medication among ED visits in which appendicitis was diagnosed. We describe use trends over time and identify use differences between adults and children.
  
  
  METHODS
  The ED component of the National Hospital Ambulatory Medical Care Survey was analyzed for 1992 through 2006, comprising a sample of 447,011 visits (representing an estimated total of approximately 1.5 billion visits), from which a sample of 1,088 patients (representing an estimated 3.7 million patients) received a diagnosis of appendicitis. The frequency of CBC and CT use and frequency of pain medication administration were determined. Survey-adjusted regression analyses were used to determine the probability of a patient receiving CBC, CT, or pain medication. Use was compared between adults and children.
  
  
  RESULTS
  During the course of the study, from 1996 to 2006, the percentage of patients with appendicitis who received a CT scan increased from 6.3% (95% confidence interval [CI] 0% to 15.3%) to 69% (95% CI 55.5% to 81.7%) for adults and from 0% to 59.8% (95% CI 31.6% to 87.9%) for children. CBC use for adults increased from 77.2% (95% CI 62.9% to 91.5%) to 92.8% (95% CI 85.8% to 99.7%) and decreased from 89.1% (95% CI 74.9% to 100.0%) to 68.4% (95% CI 41.9% to 94.9%) for children. The use of pain medications increased from 24.8% (95% CI 11.3% to 38.4%) to 69.9% (95% CI 56.7% to 83.1%) for adults and from 27.2% (95% CI 5.7% to 48.8%) to 42.8% (95% CI 18.1% to 67.5%) for children. The proportion of children who received parenteral narcotics (13.7% [95% CI 9.3% to 18.0%]) was less than that of adults (23% [95% CI 18.9% to 27.1%]).
  
  
  CONCLUSIONS
  CT use has increased for patients with appendicitis over time, and CBC use remains high. There has been an increase in analgesic administration, but more than half of all patients with appendicitis had not received pain medication over the course of the entire study period. Children received fewer parenteral narcotics than adults and appeared to be preferentially treated with nonparenteral nonnarcotic analgesics.
authors.affiliation: Department of Pediatrics, Division of Pediatric Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA. dst2141@columbia.edu
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Tsze
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Asnis
authors.forename: Roland C
authors.initials: RC
authors.lastname: Merchant
authors.forename: Siraj
authors.initials: S
authors.lastname: Amanullah
authors.forename: James G
authors.initials: JG
authors.lastname: Linakis
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D001064:Appendicitis / Q000000981:diagnostic imaging*; D001772:Blood Cell Count / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods* / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult
chemical_list: D000700:Analgesics