Computerized tomography in the workup of pediatric appendicitis: why are children scanned?
Physicians increasingly use computerized tomography (CT) for the evaluation of suspected acute appendicitis (AA) in children despite increasing awareness of the potential dangers of CT-associated radiation exposure. Many studies demonstrate the value of CT in the diagnosis of AA, but  none have determined what factors influence the decision to perform a CT. We investigated factors associated with the use of CT during initial workup of children who subsequently underwent appendectomy. This is a retrospective review of all patients aged 0 to 17 years who underwent appendectomy  for AA by pediatric surgeons over 11 years. Both univariate and multivariable logistic regression models were created to predict use of CT. A total of 546 children underwent appendectomy for AA, of which 293 (53%) underwent CT. In univariate analysis, seven variables were significantly associated  with the use of CT: female gender, Hispanic ethnicity, initial presentation to referring hospitals, lower Alvarado scores, delays from onset of symptoms to hospital presentation, migration, and rebound tenderness. In multivariable analysis, four variables significantly independently predicted  the use of CT: initial presentation to a referring hospital [odds ratio (OR) 3.50), female gender (OR 1.49), increased latency from symptom onset to presentation (OR 1.34), and the presence of rebound tenderness (OR 0.23), which had a protective effect; the overall model was statistically  significant (P < 0.0001). This model is the first to define variables that significantly predict CT utilization in the pediatric population. Continued investigation will be necessary to develop effective algorithms for judicious use of CT for suspected AA.
Wake Forest University School of Medicine, Section on Pediatric Surgery, Winston-Salem, North Carolina, USA.
Mitchell R
MR
Ladd
Lucas P
LP
Neff
Robert D
RD
Becher
Jared R
JR
Gallaher
Thomas
T
Pranikoff
D000293:Adolescent; D000465:Algorithms; D001062:Appendectomy; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; 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*