Diagnostic Utilization and Accuracy of Pediatric Appendicitis Imaging at Adult and Pediatric Centers

Background: Diagnostic imaging in pediatric appendicitis may decrease rates of negative appendectomy and identify alternate pathologies. We compared imaging practices for children transferred from nonpediatric facilities versus directly admitted to our tertiary children's hospital for laparoscopic appendectomy, and assessed the diagnostic accuracy in each population based on final pathologic diagnosis. Materials and methods: After institutional review board approval, all cases of laparoscopic appendectomy at our children's hospital during 2015 were reviewed. Demographic and clinical data were collected, including age, transfer status, imaging studies, and pathologic diagnosis. Imaging practices in patients transferred from adult centers were compared with those directly admitted. Results: There were 1153 included patients who underwent laparoscopic appendectomy for acute appendicitis during the study period, with 242 (20.9%) presenting as transfers from nonpediatric facilities. Of these, 73.5% underwent preoperative computed tomography (CT), compared with 26.4% of nontransfer patients (P < 0.000). All remaining patients received ultrasound (US). Despite variation in imaging strategies, rates of negative appendectomy were similar in transfer and nontransfer groups (1.7% versus 2.0%, respectively, P = 0.744). There were marginal differences in sensitivity of US and CT to detect appendix features between the transferring and referral centers. Conclusions: Our results show that nonpediatric facilities use CT more frequently to diagnose pediatric appendicitis. Rates of nontherapeutic surgery were equivalent between transferred and directly admitted patients, which is likely related to high performance of both imaging strategies. Transferring centers should strive to rely more heavily on US, which may require education and development of improved pediatric US capacity.