312 Compliance With Head Injury Imaging Guidelines for Adolescent Trauma Patients: Difference Between Adult and Pediatric Trauma Teams

Abstract

including 17,000 pediatric patients) and busy tertiary care pediatric hospital (80, 000 ED visits annually) from January 2015 to December 2020. Patients were included if they had an age less than or equal to 18 years, had an ultrasound done as part of their initial ED work up, and had appendicitis confirmed on surgical pathology. Patients were excluded if an alternate diagnosis was found on pathology or if their appendix was not removed during the same hospitalization. A multivariate analysis was used to compare the rates of inconclusive ultrasounds, computed tomography, magnetic resonance imaging, and ruptured appendicitis. All tests were two-sided and performed using SAS EG 7.13 (Cary, NC). P values of less than 0.05 were considered statistically significant.Results: There were 256 patients at the community hospital and 2,925 patients at the pediatric hospital that met all criteria. Both hospitals had similar baseline demographics (age, sex, body mass index, weight, and weight-for-age percentile). The community ED had a higher inconclusive rate of ultrasound (41% vs. 34.7%, p ¼0.04) and a higher rate of subsequent computed tomography imaging (43% vs 20.8%, p<0.0001) than the pediatric ED. The pediatric hospital has a higher rate of ruptured appendicitis compared to the community hospital (33.3% vs 12.9%, p<0.0001).Conclusion: Pediatric emergency departments more accurately diagnosed appendicitis using ultrasound. Pediatric patients with appendicitis presenting to a community hospital are more likely to have an inconclusive ultrasound leading to subsequent utilization of computed tomography.