title: Performance of CT examinations in children with suspected acute appendicitis in the community setting: a need for more education.
abstract: OBJECTIVE
  Despite a recent focus on the preferential use of ultrasound over CT for pediatric appendicitis, most children transferred from community hospitals still undergo diagnostic CT scans. The purpose of this study was to evaluate CT techniques performed for children with acute appendicitis at nonpediatric treatment centers.
  
  
  METHODS
  All patients treated for acute appendicitis at our tertiary-care pediatric hospital from July 1, 2011, through June 30, 2012, were identified. Patient demographics, imaging modality used to diagnoses appendicitis (CT or ultrasound), location (home or referral institution), and CT technique parameters were collected. The estimated mean organ radiation dose, number of imaging phases, and use of contrast media were evaluated at home and referral institutions.
  
  
  RESULTS
  During the study period, 1215 patients underwent appendectomies after imaging, with 442 (36.4%) imaged at referral facilities. Most referral patients received a diagnosis by CT (n=384, 87%), compared with 73 of 773 (9.4%) who received a diagnosis by CT at the home institution. The estimated mean (±SD) organ radiation dose was not statistically significantly different between home and referral institutions (13.5±7.3 vs 12.9±6.4 mGy; p=0.58) for single-phase examinations. Of 384 referral patients, 344 had images available for review. In total, 40% (138/344) of patients from referral centers were imaged with suboptimal CT techniques: 50 delayed phase only, 52 dual phase (eight of which were imaged twice in delayed phase), eight triple phase, and 36 without IV contrast agent.
  
  
  CONCLUSIONS
  CT parameters and radiation doses from single-phase examinations in children with appendicitis were similar at nonpediatric treatment centers and a tertiary care children's hospital. Future educational outreach should focus on optimizing other technical parameters.
authors: 1 Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors: Michael E
authors: ME
authors: Kim
authors: Robert C
authors: RC
authors: Orth
authors: Sara C
authors: SC
authors: Fallon
authors: Monica E
authors: ME
authors: Lopez
authors: Mary L
authors: ML
authors: Brandt
authors: Wei
authors: W
authors: Zhang
authors: George S
authors: GS
authors: Bisset
mesh_terms: D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D005260:Female; D006764:Hospitals, Community; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D011829:Radiation Dosage; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014463:Ultrasonography
chemical_list: D003287:Contrast Media
keywords: ALARA; CT; appendicitis; pediatrics; ultrasound