title: Postoperative timing of computed tomography scans for abscess in pediatric appendicitis.
abstract: BACKGROUND
  One-quarter to one half of pediatric appendicitis patients present with ruptured appendicitis and about 3%-25% go on to form postoperative intra-abdominal abscesses. The optimal timing of postoperative imaging for suspected abscess formation has been a subject of debate.
  
  
  METHODS
  All patients who underwent appendectomy for complex appendicitis and were not discharged before postoperative day (POD) #5 from April 2012-October 2014 were identified. Patients were stratified into groups for comparison as follows: group 1 had postoperative computed tomography (CT) scans before POD#7 (n = 26) and group 2 did not (n = 169). Group 2 was further divided into those who were afebrile (group 2a, n = 106) or febrile (group 2b, n = 63) at POD#5.
  
  
  RESULTS
  A total of 195 patients met criteria. Early use of CT scans resulted in more drainage procedures (group 1, 73.1% versus group 2b, 28.6%, P < 0.001) and a higher recurrent CT scan rate (38.5% versus 9.5%). The groups had equivalent lengths of stay (11.9 versus 9.8 d, P = 0.10) and readmission rates due to abscesses (19.2% group 1 versus 6.3%, group 2b, P = 0.12) with no septic events. In total, 130 of the 169 patients (76.9%) in group 2 had resolution of symptoms before discharge without intervention with readmission for abscess in only 5.9%.
  
  
  CONCLUSIONS
  Waiting until POD#7 before scanning led to fewer drainage procedures and recurrent CT scans without increasing length of stay or readmission rates. Most complex appendicitis patients still admitted at POD#5 had resolution of symptoms without need for intervention.
authors.affiliation: Department of Surgery, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Nielsen
authors.affiliation: Department of Quality Improvement Services, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Kelli J
authors.initials: KJ
authors.lastname: Kurtovic
authors.affiliation: Department of Surgery, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Kenney
authors.affiliation: Department of Surgery, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio. Electronic address: karen.diefenbach@nationwidechildrens.org.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Diefenbach
mesh_terms: D018784:Abdominal Abscess / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000628:therapy; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: Abscess; Appendicitis; CT; Timing