Imaging utilization in the management of appendicitis and its impact on hospital charges

Abstract

The objective of this study is to assess the trends in imaging utilization in adults with diagnosis of appendicitis and the role that imaging plays in the escalating appendicitis hospital charges. Data on demographics, imaging utilization, and charges of all patients discharged after a diagnosis of appendicitis during 6 years (1999-2004) were obtained from the integrated database of a large hospital. The number of discharges from 1999 to 2004 in the institution steadily decreased. An average of 2.34 imaging studies per patient were obtained, increasing from 1.85 in 1999 to 3.07 in 2004 (p = 0.001). Computed tomography (CT) studies represented 65.9% of the total of studies obtained, while plain films and ultrasound represented 19 and 14%, respectively. The percentage of patients who underwent CT increased from 51.4 to 75.7%, with relative decreases of 12 and 54% for plain abdominal films and ultrasound, respectively. Patients older than 65 years had higher rates of imaging utilization, averaging 4.3 compared with 1.86 studies in their younger counterparts (p = 0.001). Imaging utilization rates did not significantly differ among races (p > 0.5), genders (p > 0.8), discharge services (p > 0.1), or payer groups (p > 0.5). Average hospital charges for appendicitis increased by 16.3%, while imaging charges increased as a fraction of hospital charges from 7.89 to 10.87%. Imaging utilization has increased rapidly, but trends show a slowdown that might correspond with achievement of standardization. This suggests that long-term continuous rising is unlikely. Imaging charges correlate with increased hospital charges but cannot explain or accurately predict them.

A comparative study between abdominal plain radiography and ultrasonography in non-traumatic acute abdominal emergencies in tertiary care hospital

“…Most of the patients (33/140) were in age group of [11][12][13][14][15][16][17][18][19][20] Years with mean age as 33.92±17.40 years (Table 1). Male to female ratio is 1.12 with 74 males and 66 females ( Figure 1).…”

Influence of the use of Decision Tools for Appendicitis and Diverticulitis on Diagnostic Certainty in the Emergency Department

“…Acute appendicitis and acute diverticulitis are frequently suspected serious causes for acute abdominal pain [1][2][3]. Correctly identifying patients with acute appendicitis or acute diverticulitis is a diagnostic challenge [4][5][6][7][8][9][10][11]. Guidelines often suggest that both these diagnoses can be made based on history and physical examination [12,13].…”

“…However, only 50% of patients with clinical suspicion, who are referred for imaging, are ultimately diagnosed with acute appendicitis or diverticulitis [1]. This implies over-utilization of imaging modalities [6][7][8][9][10][11][12][13][14][15]. Additionally, approximately 90% of patients have uncomplicated diverticulitis and imaging may be omitted because it will not alter the management [6,12,13].…”

“…Over-utilization of additional imaging places an unnecessary burden on both patients and health care facilities [4,11,[16][17][18][19]. Selective use of imaging in patients suspected of acute appendicitis and diverticulitis would improve both patient satisfaction and reduce health care costs.…”

Atypical appendicitis: diagnostic value of volume-rendered reconstructions obtained with 16-slice multidetector-row CT

“…Atypical appendicitis is more frequent in the elderly, in children, in pregnant women, in subjects with other diseases (diabetes, Crohn's disease, ovarian and tubal disorders) and especially in patients with anatomical variants of the location of the appendix [5]. Diagnostic imaging plays an important role in this group of subjects, reducing the number of laparotomies and the risk of complications [6][7][8].…”