title: Diagnostic imaging for acute appendicitis: interfacility differences in practice patterns.
abstract: OBJECTIVE
  To evaluate trends and factors associated with interfacility differences in imaging modality selection in the diagnosis and management of children with suspected acute appendicitis.
  
  
  METHODS
  We conducted a retrospective review of diagnostic imaging selection and outcomes in patients <20 years of age who underwent appendectomy at a single Children's Hospital from June 2008 to June 2013. These results were then compared with those of referring hospitals.
  
  
  RESULTS
  A total of 232 children underwent appendectomy during the study period. Imaging results contributed to diagnostic and management decisions in 95.3 % of cases. CT scan was utilized as first-line imaging in 50 % of cases. CTs were preferentially performed at referring institutions (78 vs. 46 %, p < 0.001). Children were five times more likely to undergo CT at referring institutions (OR = 5.5, CI 3.0-10.2). Adjusting for demographics and Alvarado score, diagnostic imaging choice was independent of patient's clinical status.
  
  
  CONCLUSIONS
  This study demonstrates that initial presentation to a referring hospital independently predicts the use of CT scan for suspected acute appendicitis. Further efforts should be undertaken to develop a clinical pathway that minimizes radiation exposure in the diagnosis of acute appendicitis, with focus on access to pediatric abdominal ultrasound.
authors.affiliation: Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Michailidou
authors.forename: Maria G
authors.initials: MG
authors.lastname: Sacco Casamassima
authors.forename: Omar
authors.initials: O
authors.lastname: Karim
authors.forename: Colin
authors.initials: C
authors.lastname: Gause
authors.forename: Jose H
authors.initials: JH
authors.lastname: Salazar
authors.forename: Seth D
authors.initials: SD
authors.lastname: Goldstein
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed