title: Use and accuracy of diagnostic imaging in the evaluation of pediatric appendicitis.
abstract: BACKGROUND
  There are safety concerns about the use of radiation-based imaging (computed tomography [CT]) to diagnose appendicitis in children. Factors associated with CT use remain to be determined.
  
  
  METHODS
  For patients ≤18 years old undergoing appendectomy, we evaluated diagnostic imaging performed, patient characteristics, hospital type, and imaging/pathology concordance (2008-2012) using data from Washington State's Surgical Care and Outcomes Assessment Program.
  
  
  RESULTS
  Among 2538 children, 99.7% underwent pre-operative imaging. 52.7% had a CT scan as their first study. After adjustment, age >10 years (OR 2.9 (95% CI 2.2-4.0), Hispanic ethnicity (OR 1.7, 95% CI 1.5-1.9), and being obese (OR 1.7, 95% CI 1.4-2.1) were associated with CT use first. Evaluation at a non-children's hospital was associated with higher odds of CT use (OR 7.9, 95% CI 7.5-8.4). Ultrasound concordance with pathology was higher for males (72.3 vs. 66.4%, p=.03), in perforated appendicitis (75.9 vs. 67.5%, p=.009), and at children's hospitals compared to general adult hospitals (77.3 vs. 62.2%, p<.001). CT use has decreased yearly statewide.
  
  
  CONCLUSIONS
  Over 50% of children with appendicitis had radiation-based imaging. Understanding factors associated with CT use should allow for more specific QI interventions to reduce radiation exposure. Site of care remains a significant factor in radiation exposure for children.
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA; Surgical Outcomes Research Center (SORCE), University of Washington, Seattle, WA, USA; CHASE Alliance, University of Washington, Seattle, WA, USA. Electronic address: mkotagal@uw.edu.
authors.forename: Meera
authors.initials: M
authors.lastname: Kotagal
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA; Department of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Morgan K
authors.initials: MK
authors.lastname: Richards
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA; Surgical Outcomes Research Center (SORCE), University of Washington, Seattle, WA, USA; CHASE Alliance, University of Washington, Seattle, WA, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
authors.affiliation: Department of General and Thoracic Surgery, Mary Bridge Children's Hospital, Tacoma, WA, USA.
authors.forename: Stephanie P
authors.initials: SP
authors.lastname: Acierno
authors.affiliation: Department of Pediatric Surgery, Swedish Medical Center, Seattle, WA, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Weinsheimer
authors.affiliation: Department of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Goldin
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D058996:Quality Improvement; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000592:standards / Q000706:statistics & numerical data; D014861:Washington
keywords: Appendicitis; Patient safety; Surgery
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