Diagnostic imaging for acute appendicitis: interfacility differences in practice patterns

Maria Michailidou, Maria G. Sacco Casamassima, Omar Karim, Colin Gause, Jose H. Salazar, Seth D. Goldstein, Fizan Abdullah*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Purpose: To evaluate trends and factors associated with interfacility differences in imaging modality selection in the diagnosis and management of children with suspected acute appendicitis. Methods: We conducted a retrospective review of diagnostic imaging selection and outcomes in patients <20 years of age who underwent appendectomy at a single Children’s Hospital from June 2008 to June 2013. These results were then compared with those of referring hospitals. Results: A total of 232 children underwent appendectomy during the study period. Imaging results contributed to diagnostic and management decisions in 95.3 % of cases. CT scan was utilized as first-line imaging in 50 % of cases. CTs were preferentially performed at referring institutions (78 vs. 46 %, p < 0.001). Children were five times more likely to undergo CT at referring institutions (OR = 5.5, CI 3.0–10.2). Adjusting for demographics and Alvarado score, diagnostic imaging choice was independent of patient’s clinical status. Conclusion: This study demonstrates that initial presentation to a referring hospital independently predicts the use of CT scan for suspected acute appendicitis. Further efforts should be undertaken to develop a clinical pathway that minimizes radiation exposure in the diagnosis of acute appendicitis, with focus on access to pediatric abdominal ultrasound.

Original languageEnglish (US)
Pages (from-to)355-361
Number of pages7
JournalPediatric Surgery International
Issue number4
StatePublished - Mar 17 2015


  • Appendicitis
  • Computed tomography
  • Imaging choice
  • Pediatric
  • Ultrasonography

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery


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