The Effects of Preoperative Imaging on Surgical Outcome for Pediatric Appendicitis Patients Special Issue: Pediatric Surgery

Computed tomography (CT) has been the major imaging modality for the diagnosis of appendicitis because of its excellent imaging resolution and the ease of interpretation, but a concern has been raised regarding radiation exposure. We have shifted from CT to ultrasonography (US) as the primary imaging modality because of this concern. A retrospective review is conducted to determine whether a combined US/CT strategy can reduce radiation exposure while maintaining the same surgical outcome. Five hundred eighty-six patients between 10 and 18 years of age who underwent an appendectomy from 2007-2011wereincluded in our study. The patients were classified as Early (prior to 7/1/2009) or Late (after 7/1/2009) with the knowledge that a conscientious institutional effort was made to start utilizing US as the primary imaging modality, limiting CT use to selective cases in 2009. The diagnostic imaging studies performed (CT, US or no imaging) were recorded. Operative findings, pathology reports and clinical course were reviewed. The rates of acute appendicitis (AA), negative appendectomies (NA) and perforated appendicitis (PA) were calculated. During the Early period, 49.3% of patients (n = 150) had undergone CT scans prior to their appendectomy whereas only 37.9% (n = 107) had CT scans during the Late period. Of the CT scans obtained during the Late period, only 18.4% of patients (n = 52) had a CT scan first, and 55 CT scans were done after an initial US. Patient disease patterns were similar between Early and Late years. While no difference in NA rates for boys was found between the Early and Late periods, a significantly higher incidence of NA rates was found in girls in the Early period as opposed to the Late period. We conclude that a shift in practice patterns to reduce radiation exposure for pediatric patients with appendicitis has not resulted in inferior surgical outcome.