Increasing utilization of abdominal CT in the Emergency Department of a secondary care center: does it produce better outcomes in caring for pediatric surgical patients?

Abstract

PurposeThe use of abdominal computed tomography (ACT) utilization is increasing to a remarkable extent in the pediatric Emergency Department (ED), but the clinical benefit of increased use of ACT for pediatric surgical patients remains uncertain.MethodsA retrospective review was conducted to investigate if, for patients who had visited pediatric ED during the last 5 years, increasing utilization of ACT would increase the detection rate of acute appendicitis, increase the detection rate of surgical conditions other than appendicitis, and decrease the hospital admission rate for surgical conditions.ResultsDuring the study period, there were 37,918 ED visits; of these, 3,274 (8.6%) were for abdominal pain, 844 (2.2%) had ACT performed. The annual proportional increase of the ACT was statistically significant (1.56% to 2.46%, P = 0.00), but the detection rate of acute appendicitis (3.3% to 5.1%) or other surgical conditions (1.7% to 2.8%) showed no statistically significant changes. Hospital admission rates (5.6% to 6.8%) also showed no significant changes during the study period.ConclusionIncreasing utilization of ACT does not lead to the improved outcomes in caring for pediatric surgical patients visiting the pediatric ED. Careful evaluation for the indication for ACT is needed in the pediatric ED.

Trends in Renal-Cell Carcinoma Incidence and Mortality in the United States in the Last 2 Decades: A SEER-Based Study

“…The changes in the incidence rate may be attributed to incidental diagnosis and/or changes in the prevalence of RCC risk factors. Recently, there has been a significant increase in the use of advanced abdominal imaging in the evaluation of unrelated abdominal symptoms (15,16). For example, a recent study found that the frequent use of CT scans is associated with increased risk of undergoing a nephrectomy (17).…”

Inconclusive abdominal CT findings in pediatric patients with appendicitis: lessons from negative appendectomy cases

“…Recommending ACT as a first-line radiological evaluation is not a key message in our study, and it has already been proven that the increasing utilization of ACT does not decrease the negative appendectomy rate. 20,21 We also believe in the policy of reducing radiation exposure as much as possible, and the purpose of our study was to provide some clues to help differentiate true and negative appendicitis for patients with inconclusive ACT results. As an alternative to ACT, magnetic resonance imaging (MRI) has been shown to have better diagnostic accuracy without the risk of radiation exposure and might supplant the role of ACT in pediatric appendicitis.…”