title: Diagnostic imaging practices for children with suspected appendicitis evaluated at definitive care hospitals and their associated referral centers.
abstract: OBJECTIVE
  The purpose of this study was to compare rates of ultrasound (US) and computed tomography (CT) for suspected appendicitis at hospitals able to provide definitive surgical care with those from their associated referral hospitals.
  
  
  METHODS
  A retrospective cohort study of children undergoing appendectomy using the Pediatric NSQIP Appendectomy Pilot Database (1/1/2013-8/31/2014) was performed. Imaging rates at the initial hospital of presentation were compared between groups after adjusting for differences in demographic characteristics.
  
  
  RESULTS
  We identified 4859 patients from 28 definitive care hospitals, of which 35% underwent diagnostic imaging at a referral hospital prior to transfer (range: 20.3-70.4%). The overall odds of receiving a CT scan was 10.9-times greater (95% CI: 9.4-12.5) at referring hospitals compared to definitive care hospitals, and the odds were significantly higher for referral hospitals in 96% (27/28) of the geographic regions represented. The overall odds of an initial attempt at US prior to CT was 11.1 times greater (95% CI: 9.09-14.28), and the odds of receiving any ultrasound was 6.25-times greater (95% CI: 5.26-7.14) at definitive care hospitals compared to referral hospitals.
  
  
  CONCLUSIONS
  Children initially evaluated for suspected appendicitis at referring hospitals are much more likely to receive a diagnostic CT, and those imaged with CT are much less likely to receive an US as the initial diagnostic test.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Boston-Harvard Medical School, Boston, MA, USA.
authors.forename: Charity C
authors.initials: CC
authors.lastname: Glass
authors.affiliation: Department of Pediatric Surgery, St. Louis Children's Hospital, Washington University, St. Louis, MO, USA.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Saito
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Boston-Harvard Medical School, Boston, MA, USA.
authors.forename: Feroze
authors.initials: F
authors.lastname: Sidhwa
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Boston-Harvard Medical School, Boston, MA, USA.
authors.forename: Danielle B
authors.initials: DB
authors.lastname: Cameron
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Boston-Harvard Medical School, Boston, MA, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Feng
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Boston-Harvard Medical School, Boston, MA, USA.
authors.forename: Mahima
authors.initials: M
authors.lastname: Karki
authors.affiliation: Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA; Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Marjorie J
authors.initials: MJ
authors.lastname: Arca
authors.affiliation: Department of Pediatric Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Goldin
authors.affiliation: Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Barnhart
authors.affiliation: Department of Anesthesia, Children's Hospital Boston-Harvard Medical School, Boston, MA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Boston-Harvard Medical School, Boston, MA, USA. Electronic address: shawn.rangel@childrens.harvard.edu.
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
mesh_terms: D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D012189:Retrospective Studies; D063728:Secondary Care Centers / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014463:Ultrasonography / Q000706:statistics & numerical data*; D014481:United States
keywords: Appendicitis; Child; Computed tomography; Diagnostic imaging and evaluation; Ultrasound