Doing Just as Well — With Less

Ultrasounds for appendicitis in children just as effective as previous CT scan use

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) There is a wide range of ways to look into the human body. Some of these involve higher costs and risks — especially for children — than others.

A recent study found that using a less expensive and less risky type of imaging tool initially for children with appendicitis was just as good as past practices using another tool first.

The tool that had frequently been used in the past to diagnose appendicitis was a CT scan, which can involve radiation.

Starting in 2006, though, doctors were encouraged to use ultrasounds first to diagnose appendicitis.

Ultrasounds do not involve radiation and cost less money than CT scans. A CT scan can still be used after the ultrasound if needed.

"Ask the doctor to explain your child's treatment options."

The study, led by Jenna Le, of Department of Radiology at Montefiore Medical Center in New York City, aimed to see whether children with appendicitis did just as well when ultrasounds were used first instead of CT scans.

The researchers reviewed the medical records of 804 children who had appendicitis between 2005 and 2011.

Then they looked at which of these children had received a CT scan first and which had received an ultrasound first.

During a CT scan, a child receives a series of X-rays showing different "slices" of their body.

However, CT scans expose children to more radiation than standard X-rays and cost more money than X-rays and ultrasounds.

During an ultrasound, sound waves are sent into a child's body with a special device that then creates an image based on how those sound waves bounce back. A child is not exposed to any radiation with an ultrasound.

Sometimes a CT scan may still be necessary after an ultrasound, but often the ultrasound is sufficient.

The researchers found that the use of CT scans as a first diagnostic test did gradually decline over the time period studied — from 43 percent of cases in the first year to less than 10 percent of cases by the last.

At the same time, the use of ultrasound among the patients gradually increased — from about 33 percent at the beginning of the study to 90 percent by the last year.

By the end of the study period, approximately 35 percent of patients still received a CT scan, but most of these patients underwent ultrasounds first.

There was also an increase in the patients who only received an ultrasound and never ended up needing a CT scan during the seven years studied.

Yet, during this time period, there was no increase in the percentage of patients who had complicated appendicitis.

There was also no change seen in the length of time that patients spent in the hospital.

In other words, the complications, outcomes and recoveries of the children appeared to remain the same even as the use of CT scans decreased and use of ultrasounds increased.

"This transition served to limit medical radiation exposure in children with suspected appendicitis without observable adverse consequences," the researchers wrote.

According to Adam Powell, PhD, a health economist and President of Payer+Provider Syndicate, this study shows "it is possible to maintain clinical outcomes while switching from a CT-first to an ultrasound-first approach to evaluating acute appendicitis in children."

This approach offers two advantages in one, he noted.

"While doing so obviously lowers costs, it has the added benefit of reducing the radiation exposure that children experience. A CT scan uses radiation, while an ultrasound does not," he said.

"Given that trying the more conservative ultrasound first approach did not increase the proportion of patients with complicated appendicitis or the median length of stay, the approach can be supported on both cost and quality grounds," Dr. Powell said.

The study was published in the December issue of the American Journal of Roentgenology.

The research was funded by the National Institutes of Health. Information regarding disclosures was not provided.

Review Date: 
December 6, 2013
Last Updated:
December 9, 2013