The use of more ultrasound translates to less CT use for diagnosing appendicitis in children, according to research published August 4 in the Journal of Surgical Research.
A team led by Jack Scaife from the University of Utah in Salt Lake City found a negative correlation between increasing ultrasound use and concurrent CT use for these indications. It also found that white children and children living in lower socioeconomic neighborhoods are more likely to visit hospitals with high concurrent imaging use.
“These findings indicate that hospital experience in ultrasound and patient socioeconomic factors are correlated to overimaging,” Scaife and colleagues wrote.
Imaging guidelines recommend using ultrasound first to evaluate possible appendicitis to minimize radiation exposure. However, the researchers noted that it’s not clear how ultrasound and CT use for diagnosing appendicitis in children are associated. They added that “very little” is known about whether overimaging practices disproportionately impact various patient demographic groups.
Previous research suggests that over the past 15 years, widespread CT use in assessing possible pediatric appendicitis has been decreasing while ultrasound has increased.
Scaife et al studied how increased ultrasound use correlated with CT use in evaluating and diagnosing pediatric acute appendicitis. Using the 2019 Nationwide Emergency Department Sample, the researchers included 485 hospitals and 23,976 pediatric patients (under 18 years old) in their retrospective analysis.
Of the total patients, 34% were treated at hospitals in the lowest tertile hospital. Another 35% were at the middle tertile hospitals and 31% were treated at the highest tertile hospitals.
The team observed a negative correlation between increased ultrasound use and concurrent imaging use. This included a correlation of -0.27 (p < 0.001).
Also, compared to white patients, Black and Hispanic patients had lower odds of presenting to a hospital with a higher concurrent imaging rate. This included adjusted odds ratios (aOR) of 0.6 and 0.7, respectively.
Finally, compared with the highest income quartile, patients in the second and lowest income quartiles had higher odds of presenting to a hospital with a higher concurrent imaging rate. His included aORs of 1.9 and 3.7, respectively.
The study authors suggested that universal adoption of ultrasound use in diagnosing appendicitis may help minimize disproportionate radiation exposure. They also highlighted that increased ultrasound use can decrease emergency department visit costs and length of stay.
“This study’s findings agree with the previous research and suggest that lower socioeconomic pediatric patients are over-imaged compared to their peers in a higher socioeconomic stratification,” they concluded.
The full study can be found here.
