title: Computerized tomography utilization in children with appendicitis-differences in referring and children's hospitals.
abstract: Increasingly, physicians rely on computerized tomography (CT) to aid in the workup of acute appendicitis (AA) in children despite the potential negative effects of CT-associated radiation exposure. Few studies have investigated the context or location in which the decision to perform  CT for AA is made. We sought to determine where the decision to use CT was made during the initial workup of pediatric patients who later underwent an appendectomy. We reviewed the medical record of all patients at a children's hospital (CH) receiving appendectomy over 10.5 years. We abstracted  clinical variables using an established clinical AA scoring system, demographics and outcome variables. Patients who underwent CT were compared with those who did not. Additionally, we identified the location where the CT was performed. Our children's hospital was compared with referring hospitals  (RHs) with regard to utilization of CT imaging. Five hundred and forty-six patients underwent appendectomy for AA at CH. Of these, 50 per cent underwent CT. Patients who initially presented at the RHs underwent CT at a significantly higher rate than those first presenting to CH (P <  0.0001). Moreover, we found that unlike at the RHs, patients with a higher AA score underwent CT at CH less often (P < 0.0002). RHs used CT more often than CH to diagnose AA in our cohort. CH avoided CT for patients with higher Alvarado scores. Further research is needed to elucidate  factors that lead healthcare providers to use CT for children with suspected AA to eliminate unnecessary CT-associated radiation exposure.
authors.affiliation: Wake Forest University School of Medicine, Section of Pediatric Surgery, Winston-Salem, North Carolina, USA.
authors.forename: Lucas P
authors.initials: LP
authors.lastname: Neff
authors.forename: Mitchell R
authors.initials: MR
authors.lastname: Ladd
authors.forename: Robert D
authors.initials: RD
authors.lastname: Becher
authors.forename: Ryan A
authors.initials: RA
authors.lastname: Jordanhazy
authors.forename: Jared R
authors.initials: JR
authors.lastname: Gallaher
authors.forename: Thomas
authors.initials: T
authors.lastname: Pranikoff
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000704:Analysis of Variance; D001062:Appendectomy / Q000379:methods* / Q000706:statistics & numerical data; D001064:Appendicitis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D011300:Preoperative Care / Q000379:methods; D011830:Radiation Effects; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D016896:Treatment Outcome