Failure to Significantly Reduce Radiation Exposure in Children with Suspected Appendicitis in the United States.
J Pediatr Surg
; : 161701, 2024 Aug 22.
Article
em En
| MEDLINE
| ID: mdl-39271307
ABSTRACT
BACKGROUND:
Ultrasound (US) or magnetic resonance imaging (MRI) is recommended over computed tomography (CT) as the initial imaging modality when considering a diagnosis of appendicitis in children. This reduces unnecessary radiation exposure and has excellent accuracy. We hypothesized a significant increase in US utilization and a reduction in CT utilization in hospitals across the United States.METHODS:
We retrospectively reviewed NSQIP-P data from 2015 to 2021 for patients <18 years undergoing appendectomy for acute appendicitis. Rates of US, CT, and MRI usage were compared between NSQIP-P hospitals and referring non-NSQIP-P hospitals.RESULTS:
Of the 115,186 children included, 66,303 (57.6%) were imaged in NSQIP-P hospitals, 37,962 (33.0%) in non-NSQIP-P hospitals, and 7947 (6.9%) in both. US alone was used in 53.3%, followed by CT alone in 25.1%, both US + CT in 16.4%, and MRI ± CT/US in 2.6%. Non-NSIQP-P hospitals used less US than NSQIP-P centers (38.6% vs 90.8%, P < 0.0001) and more CT (74.0% vs 25.4%, P < 0.0001). From 2015 to 2021, overall US utilization increased from 68.5% to 72.3% (p < 0.0001) while CT utilization remained unchanged (43.1%-43.2%, P = 0.07). US use increased in non-NSQIP-P centers (18.8%-25.7%, P < 0.0001) but not in NSQIP-P (71.7% vs 70.9%, p = 0.28), while CT alone decreased in both (NSQIP-P 10.1%-7.7%, P < 0.0001; non-NSQIP-P 71.0%-59.8%, P < 0.0001).CONCLUSION:
US and MRI remain underutilized in diagnosing pediatric appendicitis, especially in non-NSQIP-P hospitals. Trends show modest increase in US utilization; however, CT alone remains a highly used modality in non-NSQIP-P hospitals. Adopting diagnostic strategies from NSQIP-P centers could optimize diagnostic imaging in children. LEVEL OF EVIDENCE III.
Texto completo:
1
Coleções:
01-internacional
Temas:
Geral
/
Agentes_cancerigenos
Base de dados:
MEDLINE
Idioma:
En
Revista:
J Pediatr Surg
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Estados Unidos