Doctors find imaging ‘inequality’ in cognitively impaired kids with appendicitis

Kids with developmental impairments are more likely to undergo a CT scan for appendicitis, despite their increased radiation risks, according to new findings revealed Friday at the American College of Surgeons 2020 Quality and Safety virtual conference.

Authors of this research said the modality is likely overutilized, particularly because this population cannot communicate their symptoms as easily as other children, making diagnosis more difficult.

And after looking at data from nearly 17,000 patients under 18 years old, the team suggested ultrasound may be a better initial workup test.

"The disease severity is the same in both groups, yet to make a diagnosis, we are using CT scans at a higher rate, which requires the use of radiation instead of the ultrasound, which is what we advocate nowadays, especially in the pediatric population," lead author, Raphael H. Parrado, MD, a general surgery resident at the Medical University of South Carolina, Charleston, said in a statement.

Appendicitis ranks among the most common causes of abdominal pain in children, and the top surgical emergency in those under 18. To understand how to better treat these individuals, the authors looked at data from 16,986 kids included in a national surgical quality improvement database who underwent a laparoscopic appendectomy in 2018. Of that total cohort, 293 kids had developmental and cognitive impairments.

Looking at outcomes, kids with such difficulties tended to be slightly younger (10 versus 11 years old) and received more CT scans than those without developmental issues (55% vs. 41%).

Parrado and colleagues noted other stark differences between these pediatric populations. For example, kids with cognitive delays were more often readmitted (8% vs. 3%) and sent to the emergency department post-surgery (13% vs. 8%) compared to their non-impaired peers.

And while there was no difference in postoperative complications between the two groups, kids with cognition problems faced an average hospital stay of two days compared to one day for their counterparts.

Co-author Robert Cina, MD, also with the Charleston institution said rates should, in theory, be the same because doctors are treating the same disease. If anything, the results suggest there’s much room for improvement.

"The takeaway from this research is that we are treating the children with the best of our ability, but there is still room for improvement," he added. "We see that there is some inequity in how this fragile patient population is undergoing imaging. But our study allows us to look at this issue in a deeper way to see how we can improve the outcome for these kids.

“We need to make sure that we use the same processes in making our diagnoses as we would for others in regard to radiation,” Cina concluded.