A Review of Pediatric Appendicitis Imaging Trends from 2006-2020 Using the Nationwide Emergency Department Sample

Bradley End; Kimberly Quedado; Garrick Anderson; Syed Kazmi; Hansol Chung; Jessica Neidhardt; Courtney Cundiff; Wei Fang; Joseph Minardi

doi:10.1016/j.jemermed.2024.07.012

A Review of Pediatric Appendicitis Imaging Trends from 2006-2020 Using the Nationwide Emergency Department Sample

J Emerg Med. 2024 Aug 14:S0736-4679(24)00236-1. doi: 10.1016/j.jemermed.2024.07.012. Online ahead of print.

Authors

Bradley End¹, Kimberly Quedado², Garrick Anderson², Syed Kazmi², Hansol Chung², Jessica Neidhardt², Courtney Cundiff², Wei Fang³, Joseph Minardi²

Affiliations

¹ Department of Emergency Medicine, West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center, Morgantown, West Virginia; Department of Medical Education, West Virginia University School of Medicine, Morgantown, West Virginia. Electronic address: bradley.end@hsc.wvu.edu.
² Department of Emergency Medicine, West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center, Morgantown, West Virginia.
³ West Virginia Clinical & Translational Science Institute, Morgantown, West Virginia.

PMID: 39694769
DOI: 10.1016/j.jemermed.2024.07.012

Abstract

Background: Appendicitis is a common surgical emergency in the pediatric population, affecting over 70,000 children per year in the United States alone. While historically practitioners predominately used computed tomography (CT) as the main diagnostic imaging modality, multiple professional societies have released guidelines recommending an ultrasound (US) first strategy when using imaging to confirm suspected appendicitis in pediatric populations. To date, no studies have quantified the change in imaging trends for pediatric appendicitis across the spectrum of healthcare facilities in the United States utilizing the Nationwide Emergency Department Sample (NEDS).

Objectives: We aimed to evaluate the imaging trends for pediatric appendicitis across the nation, stratified by age and gender. Specifically, we wanted to delineate the use of CT alone versus US alone or US first imaging strategies.

Methods: This retrospective cross-sectional study utilized data from the NEDS spanning from 2006 through 2020. We examined and analyzed the total number of patients, the number of patients with available imaging data, sex, age, and included imaging modalities utilizing descriptive statistics and regression analyses. Similarly, regression analysis was employed to discern differences in imaging rates in time intervals following societal imaging recommendations.

Results: From 2006 to 2020 the database recorded 160,828 encounters for pediatric appendicitis. Imaging data was available for 101,248 encounters, accounting for 63% of the total sample. Over the study period, both rates of "US only" and "US first" imaging modalities increased (from 5.5% to 38.9% and 8.9% to 55.6%, respectively), while rates of CT utilization in isolation declined (from 91.1% to 44%).

Conclusion: While there is an increasing trend towards US being used as the first imaging modality to diagnose pediatric appendicitis across the spectrum of facilities included in the NEDS, continued utilization of CT to diagnose appendicitis remains unacceptably high in the pediatric population within the limits of this retrospective study.

Keywords: Appendicitis; Computed tomography; NEDS; Pediatrics; Ultrasound.