ER reduces radiation exposure in children with suspected appendicitis

Physicians can safely reduce the use of computed tomography (CT) scans in children who have a suspected appendicitis by performing an ultrasound first, according to preliminary results of a retrospective study presented at Touro College Research Day.

"CT scans are routinely used to diagnosis acute appendicitis, but also involve radiation exposure, which is a concern when treating children," says Suhal Shah, a third-year resident at Touro College of Osteopathic Medicine. Shah collaborated with project leader Victor Todisco, MD, a pediatric radiologist at Orange Regional Medical Center. The American College of Radiology and the American College of Surgeons recommend using ultrasound first to reduce radiation exposure, but the appendix is difficult to find using this method. This study compared testing trends and outcomes of pediatric patients who came to the Orange Regional Medical Center with suspected appendicitis during two periods of time, 2011-2012 and 2014-2015.

Researchers found that rates of using CT scans first dropped from 12.8 to 7.5 percent between the two time periods. "These results show that our hospital is doing better at following the recommendations by using ultrasound first, and then if indicated, moving on to CT," says Shah. "That shows that we are limiting radiation exposure in children."

The study also found that when the appendix is found on an ultrasound, the results - both positive and negative - are accurate, and no further testing is necessary. However, ultrasounds only found the appendix in about 10 percent of cases. But even in those who had an inconclusive result, only those with a high clinical suspicion of appendicitis went on to have a CT. Of the children that did not have a CT, none returned to the hospital with a missed appendicitis.

"It's worth doing ultrasound because sometimes we can pick up a positive or negative appendicitis," says Shah. "If it's inconclusive, it's only worth moving on to doing a CT if you have high clinical suspicion, so overall, we are reducing radiation exposure." 

More research is needed to study the variables that were not taken into account in this study such as variations among physicians ordering the tests, the ultrasound technicians and radiologists.