0
0
Abdominal pain is one of the leading causes of pediatric emergency room visits. While most cases are benign, a small percentage of children with this symptom are diagnosed with appendicitis, a condition that requires prompt identification and treatment to prevent life-threatening complications.
Traditionally, physicians rely on imaging techniques such as ultrasound or CT scans to detect appendicitis in children. However, there is an ongoing challenge of balancing the urgency of a timely diagnosis with the potential harm of overtesting, especially when radiation from CT scans is involved. A study recently published in Academic Emergency Medicine explores how emergency departments (EDs) manage this delicate balance, shedding light on the differences in diagnostic practices across Michigan.
The study, led by researchers from the University of Michigan, found significant variation in how emergency departments handle the diagnosis of appendicitis in children with abdominal pain. Dr. Alexander Janke, a clinical assistant professor of emergency medicine, emphasized the dilemma faced by clinicians: “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.”
While various diagnostic tools are available, such as ultrasounds, CT scans, blood tests, and consultations with pediatric surgeons, their use differs greatly among emergency departments. For instance, not every facility is equipped with high-quality ultrasound capabilities, and access to pediatric surgical consultation can vary.
To better understand how different departments approach this issue, the researchers analyzed over 100,000 emergency department visits for children aged 5-17 years with abdominal pain, using data collected from 26 EDs in Michigan’s Emergency Department Improvement Collaborative (MEDIC) between May 2016 and February 2024. MEDIC, a quality improvement network that serves over 50 Michigan hospitals, tracks clinical practices and aims to enhance emergency care quality statewide.
The analysis revealed that among the 120,112 cases of abdominal pain, only 0.1% involved a delayed diagnosis of appendicitis. Interestingly, these delays were not linked to variations in imaging practices. Large pediatric centers were found to have the lowest rates of CT use and the fewest instances of delayed appendicitis diagnosis. Dr. Courtney Mangus, another clinical assistant professor of emergency medicine, explained, “Pediatric centers were able to accurately diagnose appendicitis without heavy reliance on CT scans, likely due to access to high-quality ultrasound, pediatric MRI protocols, and in-house pediatric surgical consultation.”
Although the study does not capture real-time clinical decision-making, it provides valuable insights into how diagnostic practices vary and suggests that adherence to best practices and greater coordination among healthcare facilities could improve pediatric care. “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 noted.
This research underscores the importance of diagnostic stewardship in optimizing care for children with abdominal pain and appendicitis, emphasizing the need for thoughtful, evidence-based decision-making in pediatric emergency care.
Disclaimer: This article is based on the findings of the study “Exploring diagnostic stewardship in the emergency department evaluation of pediatric abdominal pain in a statewide quality collaborative” published in Academic Emergency Medicine. The conclusions presented are those of the authors and may not reflect the practices of all emergency departments or clinicians.
