title: Factors associated with imaging modality choice in children with appendicitis.
abstract: BACKGROUND
  The aim of this study was to evaluate a cohort of children undergoing imaging prior to appendectomy in order to identify factors that were associated with undergoing computed tomography (CT) alone as compared to ultrasound (US) alone or US and CT.
  
  
  METHODS
  The Kids' Inpatient Database was queried for children 1-18 y of age with imaging reported. Logistic regression models identified factors associated with CT-alone imaging modality.
  
  
  RESULTS
  There were 6519 patients (69.5%) who underwent CT alone, 2076 (22.1%) who underwent US alone, and 782 (8.4%) who underwent US and CT. The negative appendectomy rates were higher for US alone (6.5%) and US and CT (6.6%) compared to the CT alone group (3.6%, P < 0.001). The perforated appendicitis rates were highest for the US and CT group (36.3%) compared to the CT alone group (31.8%) and the US alone group (29.8%, P = 0.004). Older patients were more likely to undergo CT alone compared to younger patients (odds ratio [OR] 1.44, 95% confidence interval [CI] 1.26-1.64). Girls were less likely to undergo CT alone compared to boys (OR 0.51, 95% CI 0.46-0.56). Hospital factors associated with lower CT-alone imaging included children's centers (OR 0.46, 95% CI 0.41-0.52), teaching hospitals (OR 0.53, 95% CI 0.48-0.60), and urban location (OR 0.40, 95% CI 0.32-0.49).
  
  
  CONCLUSIONS
  Though patient factors such as age and sex influence imaging use, children's centers are associated with lower CT-alone imaging compared to non-children's centers. As focus increases on limiting CT use in children, opportunities for improvement based on hospital factors exist.
authors.affiliation: Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois, USA. mehulvraval@gmail.com
authors.forename: Mehul V
authors.initials: MV
authors.lastname: Raval
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Deans
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Kelleher
authors.forename: R Lawrence
authors.initials: RL
authors.lastname: Moss
mesh_terms: D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D000075202:Contraindications; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014463:Ultrasonography