title: Association of Hospital Resources and Imaging Choice for Appendicitis in Pediatric Emergency Departments.
abstract: OBJECTIVE
  Abdominal pain and concern for appendicitis are common chief complaints in patients presenting to the pediatric emergency department (PED). Although many professional organizations recommend decreasing use of computed tomography (CT) and choosing ultrasound as first-line imaging for pediatric appendicitis, significant variability persists in imaging utilization. This study investigated practice variation across children's hospitals in the diagnostic imaging evaluation of appendicitis and determined hospital-level characteristics associated with the likelihood of ultrasound as the first imaging modality.
  
  
  METHODS
  This was a multicenter (seven children's hospitals) retrospective investigation. Data from chart review of 160 consecutive patients aged 3-18 years diagnosed with appendicitis from each site were compared with a survey of site medical directors regarding hospital resource availability, usual practices, and departmental-level demographics.
  
  
  RESULTS
  In the diagnostic evaluation of 1,090 children with appendicitis, CT scan was performed first for 22.4% of patients, with a range across PEDs of 3.1% to 83.8%. Ultrasound was performed for 54.0% of patients with a range of 2.5% to 96.9%. The only hospital-level factor significantly associated with ultrasound as the first imaging modality was 24-hour availability of in-house ultrasound (odds ratio = 29.2, 95% confidence interval = 1.2-691.8).
  
  
  CONCLUSIONS
  Across children's hospitals, significant practice variation exists regarding diagnostic imaging in the evaluation of patients with appendicitis. Variation in hospital-level resources may impact the diagnostic evaluation of patients with appendicitis. Availability of 24-hour in-house ultrasound significantly increases the likelihood of ultrasound as first imaging and decreases CT scans. Hospitals aiming to increase the use of ultrasound should consider adding 24-hour in-house coverage.
authors.affiliation: Inova Children's Hospital, Falls Church, VA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Fullerton
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Holly
authors.initials: H
authors.lastname: Depinet
authors.affiliation: Dell Children's Medical Center, Austin, TX.
authors.forename: Sujit
authors.initials: S
authors.lastname: Iyer
authors.affiliation: Children's Hospital Association, Overland Park, KS.
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.affiliation: Kosair Children's Hospital, Louisville, KY.
authors.forename: Sandra
authors.initials: S
authors.lastname: Herr
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, CA.
authors.forename: Inge
authors.initials: I
authors.lastname: Morton
authors.affiliation: Akron Children's Hospital, Akron, OH.
authors.forename: Timothy
authors.initials: T
authors.lastname: Lee
authors.affiliation: Children's Hospital of Wisconsin, Milwaukee, WI.
authors.forename: Marlene
authors.initials: M
authors.lastname: Melzer-Lange
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D001064:Appendicitis / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014463:Ultrasonography / Q000706:statistics & numerical data