ArticleEmergency radiology2026
Predictors of CT vs ultrasound use in pediatric appendicitis.
Article in Emergency radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeRight lower quadrant (RLQ) abdominal pain is a common complaint among children presenting to the emergency department. When imaging is needed to assess for acute appendicitis, ultrasound (US) or computed tomography (CT) is often utilized. Current guidelines recommend US first to limit radiation exposure. This study analyzes patterns of US versus CT use in children with suspected appendicitis and examines associated demographic factors that predict increased CT utilization.
methodsThis retrospective study involves patients less than 18 years old from the 2019 Nationwide Emergency Department Sample (NEDS). Included patients had a diagnosis of right lower quadrant abdominal pain or acute appendicitis and received either US or CT. The primary outcome was whether patients underwent US or CT. Additional demographic, clinical, and hospital characteristics were analyzed with multivariate analysis.
resultsOf 147,254 patient encounters, (mean age 12.5 ± 4.2 years) 55.2% received CT and 44.8% received US. Patients who received CT were older than those receiving US (13.9 vs. 10.8 years, p < 0.001), although there was no difference by sex. Both Hispanic and Asian/Pacific Islander patients had lower rates of CT utilization compared to Caucasian patients (OR 0.69 and 0.58, respectively, p < 0.001). Lower median household income in the patient’s zip code, non-teaching hospital status, and Midwest and South locations were associated with increased CT over US utilization.
conclusionDemographic-related disparities exist with regard to CT utilization among children diagnosed with acute appendicitis in the ED.
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