CT for pediatric appendicitis adds radiation without boosting diagnostics

Absent a surgical consult, abdominal CT for children and teens with suspected acute appendicitis does not lead to better outcomes than either ultrasound or no imaging at all, according to a study in the Western Journal of Emergency Medicine.

Researchers from the University of Connecticut and its affiliated Connecticut Children’s Medical Center arrived at this conclusion after retrospectively reviewing ED and inpatient charts of 1,493 patients under 20 years old who presented with severe abdominal pain, appendicitis suspected, from January 2009 through February 2010.

There was no control group, and all cases selected for review had either a surgical consult or an abdominal imaging study.

Of these, a little less than half, 739 patients, were sent home after ED evaluation and presumed by the research team not to have appendicitis since they did not return within two weeks following the initial visit.

Of the 754 patients who were admitted to the hospital, and thus formed the study group, 20 percent received a CT scan, 53 percent received ultrasound and 8 percent received both.

Some 95 percent of this cohort had pathology-proven appendicitis, and, among these:

  • Appendicitis rates were similar for children with a CT (57 percent) compared to those without (also 57 percent).  
  • Children had ruptured appendix at similar rates between those with a CT (18 percent) and those without (13 percent).
  • The proportion of children with a negative appendectomy was similar in both groups: CT (7 percent), ultrasound (8 percent) and neither (12 percent).

In their discussion, the authors write that, because the rate of complications proved similar across the reviewed diagnostic options, and because CT carries the added risk of radiation, “we believe that the use of CT should be reserved for children who pose diagnostic challenges or risks of other pathologies.”

Among the limitations the authors acknowledge are the study’s single-site, non-randomized design and its capture model, which relied on selection by treating physicians who may have missed some children with appendicitis.

The team calls for a prospective, multi-center study to better identify how and when to use CT in children with suspected acute appendicitis.