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Imaging for Suspected Appendicitis

Variation Between Academic and Private Practice Models

Menoch, Margaret MD; Simon, Harold K. MD, MBA; Hirsh, Daniel MD; Shim, Young MD; Baxter, Amy L. MD; Clifton, Matthew MD; Kim, Daniel MD; Sturm, Jesse J. MD, MPH

doi: 10.1097/PEC.0000000000000694
Original Articles

Background Little is known regarding the effect of different emergency department (ED) practice models on computed tomography (CT) and ultrasound (US) utilization for suspected appendicitis in the ED and through the potential inpatient hospital stay.

Objectives Examination rates of CT and US for suspected appendicitis at 2 different pediatric EDs (PEDs) through hospital admission: an academic affiliated tertiary PED (site A) compared with a private practice tertiary care PED (site B).

Methods All visits with the ICD-9 (International Classification of Diseases, Ninth Revision) chief complaint of abdominal pain were retrospectively examined from May 1, 2009, to February 21, 2012. Suspected appendicitis visits were defined as any visit with the chief complaint of abdominal pain where a complete blood cell count was obtained. Abdominal CT and US in the PED and during hospital admission were compared across the 2 sites. Return visits within 72 hours were evaluated for any missed appendicitis.

Results Overall appendicitis rates were similar at both sites: site A, 4.7%; site B, 4.0%. The odds of having a CT scan performed during visits to the PED for abdominal pain were significantly higher at site B (odds ratio [OR], 3.19; 95% confidence interval [95% CI], 2.74–3.71), whereas the odds of having an US at site B were the opposite (OR, 0.34; 95% CI, 0.28–0.40). When evaluating only the admitted visits, the odds of having a CT were also greater at site B (OR, 2.32; 95% CI, 1.86–2.94) and having an US were less (OR, 0.57; 95% CI, 0.44–0.73).

Conclusions In this study of 2 PEDs with differing practice models, we identified a dramatic difference in imaging utilization among patients with suspected appendicitis.

From the *William Beaumont Hospital, Royal Oak, MI; †Children's Healthcare of Atlanta; ‡Emory University School of Medicine; §Pediatric Emergency Medicine Associates; and ∥Pediatric Adolescent Surgical Associates, Atlanta, GA; and ¶University of Connecticut School of Medicine, Farmington, CT.

Disclosure: The authors declare no conflict of interest.

Reprints: Margaret Menoch, MD, 340 Ferndale, Birmingham, MI 48009 (e-mail:

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