Abdominal discomfort is one of the primary reasons why children visit the emergency room.
A small percentage of these cases typically involve appendicitis, making early detection crucial.
Doctors often depend on imaging techniques like ultrasounds or CT scans to diagnose the condition.
While a delay in diagnosing appendicitis in children can be life-threatening, conducting excessive tests can be wasteful and even harmful.
In a recent study published in Academic Emergency Medicine, researchers from the University of Michigan discovered significant variations in how emergency departments manage the need for diagnosing appendicitis against the risks of unnecessary testing.
“Children with abdominal pain present a diagnostic challenge. Those with appendicitis require prompt diagnosis, but the most commonly used diagnostic tool, a CT scan, exposes them to radiation,” stated Alexander Janke, M.D., a clinical assistant professor of emergency medicine.
Emergency clinicians have access to various diagnostic tools, including ultrasounds, CT scans, blood tests, and consultations with surgical specialists; however, the application of these tools differs across emergency departments in Michigan.
The availability and standard of ultrasound technology, for instance, may not be consistent in every emergency department.
Likewise, some emergency departments can readily arrange pediatric surgical consultations, while others may struggle to do so.
To explore the trade-off between unnecessary testing and delays in diagnosis, the researchers analyzed data from over 100,000 visits to emergency departments by children aged 5 to 17 experiencing abdominal pain.
The information was gathered from 26 emergency departments in the Michigan Emergency Department Improvement Collaborative from May 2016 to February 2024.
MEDIC is a quality enhancement network that supports more than 50 hospitals in Michigan, focusing on improving emergency department care.
To facilitate this, MEDIC has established a data registry that monitors clinical practices state-wide, offering insights into the use of diagnostic imaging.
The research team utilized the registry to analyze how abdominal pain in children is assessed and whether this correlates with delays in diagnosing appendicitis.
Among the 120,112 abdominal pain cases examined, only 0.1% experienced a delayed diagnosis of appendicitis, and this did not correlate with varying imaging rates.
The findings indicated that large pediatric centers manage to maintain low rates of delayed appendicitis diagnoses while also using CT scans less frequently.
“It’s not surprising that pediatric centers accurately diagnosed appendicitis without relying heavily on CT scans. This is likely attributed to their access to superior ultrasound facilities, MRI protocols for pediatric appendicitis, and on-site pediatric surgical consultations,” remarked Courtney Mangus, M.D., a clinical assistant professor of emergency medicine.
Although the study did not provide real-time insights into the decision-making processes of physicians, the researchers aim for it to serve as a stepping stone for enhancing diagnostic methods.
They believe that following best practices and improving coordination of care among different centers could better evaluate children suffering from abdominal pain.
“Different hospitals approach these cases uniquely. Diagnosis can be complicated, and our work serves as a reminder for families to feel comfortable asking questions and advocating for their children when visiting the emergency department,” noted Janke.
