Summary: A study in Academic Emergency Medicine found significant variability in imaging for pediatric appendicitis in Michigan, with large pediatric centers favoring ultrasound and MRI over CT scans to reduce radiation while ensuring timely diagnosis.

Key Takeaways

  • Imaging practices for pediatric appendicitis vary widely across Michigan hospitals, with large pediatric centers favoring ultrasound and MRI over CT scans to minimize radiation exposure.
  • Access to high-quality ultrasound and MRI allows pediatric centers to maintain accurate diagnoses with lower CT scan usage, without increasing delays in identifying appendicitis.
  • The study highlights the need for standardized diagnostic protocols to improve consistency across hospitals and reduce unnecessary radiation exposure in children.

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A new study published in Academic Emergency Medicine reveals significant variability in how emergency departments across Michigan use imaging to diagnose appendicitis in children while balancing the risks of radiation exposure. Researchers from the University of Michigan examined data from over 100,000 pediatric emergency visits and found that large pediatric centers are more likely to rely on ultrasound and MRI rather than CT scans to diagnose appendicitis.

Abdominal Pain in Kids

Abdominal pain is among the most common reasons children are brought to emergency departments. While only a small percentage of cases are due to appendicitis, timely and accurate diagnosis is critical. Clinicians often use imaging modalities such as ultrasound, CT scans, and MRI, but their availability and utilization vary widely.

“Children with abdominal pain are a diagnostic conundrum. On the one hand, those who have appendicitis need to be diagnosed in a timely manner, but on the other hand, the most common diagnostic tool we use, a CT scan, exposes them to radiation,” said Alexander Janke, M.D., clinical assistant professor of emergency medicine.

Using data from the Michigan Emergency Department Improvement Collaborative (MEDIC), researchers analyzed emergency department visits between May 2016 and February 2024. Among 120,112 cases of pediatric abdominal pain, only 0.1% had a delayed diagnosis of appendicitis, and these delays were not associated with differences in imaging rates. The study highlights that pediatric centers with access to high-quality ultrasound and MRI protocols had lower CT scan usage while maintaining low rates of delayed diagnosis.

“Unsurprisingly, pediatric centers were able to accurately diagnose appendicitis without heavy reliance on CT scans. This is likely due to their access to high-quality ultrasound capabilities, MRI protocols for pediatric appendicitis, and in-house pediatric surgical consultation,” says Courtney Mangus, MD, clinical assistant professor of emergency medicine.

Call for Standardized Pediatric Imaging

The study underscores the importance of radiologic best practices in minimizing unnecessary radiation exposure while ensuring timely diagnosis. The researchers hope their findings will encourage hospitals to adopt standardized diagnostic approaches and improve coordination across facilities.

“Different hospitals handle these cases in different ways. Diagnosis can be hard, and our work is a reminder to families that it is okay to ask questions and advocate for your child when you go to the emergency room,” Janke says.