The use of computed tomography versus clinical acumen in diagnosing appendicitis in children: A two-institution international study

Yousef El-Gohary*, Maria Molina, Jeremy Chang, Ashley Dodd, Emily Miller, Camden Harrell, Fang Wang, Hui Zhang, Andrew M. Davidoff, Israel Fernandez-Pineda, Andrew J. Murphy, Eunice Y. Huang

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: Appendicitis in children can be diagnosed utilizing clinical and laboratory findings, with the assistance of ultrasound (US) and/or computed tomography (CT). However, repeated exposure to ionizing radiation increases the lifetime risk of cancer. We compared the work-up of suspected appendicitis between a children's hospital in the United States (USA) and one in Spain to identify differences in imaging use and associated outcomes. Methods: A two-institution retrospective review was performed for surgical consultations of suspected appendicitis from 2015-2017. We compared imaging use, the utilization of overnight observation, and diagnostic accuracy rates between the two centers. Results: A total of 1,952 children were evaluated. Among the 1,288 in the USA center, 754(58.5%) underwent CT during their evaluation. The most common imaging modality was US only (39.9%), then CT only (39.3%), CT + US (19.3%), and no imaging (i.e. only clinical acumen) (1.6%). In Spain, only 19 (2.9%) of 664 children underwent CT compared to the USA (p < 0.0001). Only clinical acumen was the most common modality employed (48.6%), followed by US only (48.5%), US + CT (2.4%), and CT only (0.5%). In the USA, 16.8% were observed overnight, 2.3% of whom received no imaging. In Spain, 33.4% were observed overnight, 32.4% of whom had no imaging (p < 0.0001). The accuracy rates for diagnosing appendicitis in the USA and Spain centers were 94.7% and 95.1%, respectively. Conclusion: Use of clinical acumen and/or US have similar clinical outcomes and similar accuracy rates compared to heavy reliance on CT imaging for diagnosing appendicitis, with associated decrease in radiation exposure. The disparate diagnostic approach of the two centers may reflect that physical examination is a dying art in North America.

Original languageEnglish (US)
Pages (from-to)1356-1361
Number of pages6
JournalJournal of pediatric surgery
Issue number8
StatePublished - Aug 2021


  • Appendicitis
  • computed tomography
  • overnight observation

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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