CHICAGO: Computed tomography (CT) is used at a higher rate than ultrasound in children with developmental and cognitive impairments to diagnose appendicitis, even though CT scans increase radiation risk in smaller bodies. Additionally, these children have higher rates of postoperative emergency room visits and hospital readmissions after undergoing laparoscopic appendectomy (surgical removal of appendix) than children with normal development, according to new findings presented today by researchers at the American College of Surgeons (ACS) 2020 Quality and Safety Conference VIRTUAL.
Appendicitis is one of the most common causes of abdominal pain in children overall, as well as the most frequent surgical emergency in patients under age 18.*
In children with cognitive impairment, however, appendicitis is much more difficult to diagnose because they cannot communicate to us quite as easily as other children about their symptoms, so it makes the diagnosis more challenging, said study coauthor Robert Cina, MD, FACS, associate professor of surgery at the Medical University of South Carolina, Charleston.
The researchers used data from the ACS National Surgical Quality Improvement Program (ACS NSQIP®) database to evaluate the impact of cognitive impairment in the diagnosis and treatment of appendicitis in children. ACS NSQIP is a nationally validated, risk-adjusted, outcomes-based program designed to measure and improve the process of surgical care in participating hospitals.
The analysis involved 16,986 patients under age 18 who underwent laparoscopic appendectomy in 2018. Of these, 293 patients had developmental and cognitive impairments.
Outcomes comparisons showed that children with cognitive deficits were slightly younger (average age 10 versus 11) and had more CT scans performed than children without developmental delays (55 percent versus 41 percent).
“The disease severity is the same in both groups, yet to make a diagnosis, we are using CT scans at a higher rate, which requires the use of radiation instead of the ultrasound, which is what we advocate nowadays, especially in the pediatric population,” said the study’s lead author Raphael H. Parrado, MD, a general surgery resident at the Medical University of South Carolina.
CT scans shouldn’t be automatically performed because there are long term risks of radiation. “Our exploratory study suggests that physicians are deciding to use CT scans over ultrasound initially,” Dr. Cina said. “The reason may be that children who are neurologically impaired cannot tell us specifically about their symptoms, and as a result, they may be getting imaged more often to help make the diagnosis.”
Another important finding is that while no differences were seen in postoperative complications, readmissions and postoperative emergency department visit rates were higher in children with cognitive impairment compared to neurologically normal children; readmissions: 8 percent versus 3 percent and emergency department visits: 13 percent versus 8 percent.
