Changes in the Trend of the Imaging Study in Children with Acute Appendicitis in the Pediatric Emergency Department and Changes of the Negative Appendectomy Rate (NAR)

ABSTRACT

PURPOSE: We evaluated the relationship between changes in the trend of the utilization of diagnostic imaging studies and the rates of negative appendectomy, complications in pediatric patients with appendicitis. METHODS: This retrospective observational study was conducted at a pediatric emergency department (PED) of a tertiary university hospital. Patients who underwent imaging studies under the clinical impression of acute appendicitis and underwent appendectomy at the hospital from 2010 to 2013 were enrolled. We compared the percentages of imaging studies performed and negative appendectomy rate (NAR), complications between first two years (FTY) and second two years (STY). RESULTS: The total number of patients was 197 with a mean age of 9.68 (+/-3.17) years, and 66% were boys. The percentages of performed computed tomography (CT) of FTY and STY were 46.2% and 25.5% (p<0.05). Patients who were evaluated by ultrasound alone were 53.8% and 74.5%, respectively (p<0.05). The NARs of the two groups were 13.2% (FTY) and 8.0% (STY) (p=0.19). There was no significant difference in the number of hospital days, drainage insertion rates, duration of draining, and the rates of perforations between groups. The duration of antibiotics use was significantly longer only in the STY group than in the FTY group (6.20+/-3.95 vs. 6.94+/-3.41 days, p=0.04). CONCLUSION: Although the number of patients who underwent ultrasound without a CT scan for the diagnosis of acute appendicitis was increased, the NAR and clinically important complications were comparable from the preceding two years at a tertiary PED.