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Variation in imaging outcomes associated with individual sonographers and radiologists in pediatric acute appendicitis: a retrospective cohort of 9271 examinations

  • Gastrointestinal
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Abstract

Objective

To determine if individual sonographers and radiologists impact appendix visualization by ultrasound and utilization of computed tomography (CT) in children with suspected acute appendicitis.

Materials and methods

Appendix ultrasound examinations performed at Cincinnati Children’s Hospital Medical Center on Emergency Department patients ≤ 18 years old were retrospectively identified. Examinations performed/interpreted by sonographers/radiologists with fewer than 100 examinations were excluded. Multivariable logistic regression was used to assess the effect of sonographer, radiologist, clinical variables, and system factors on imaging outcomes, including appendix visualization and subsequent CT utilization.

Results

A total of 9271 ultrasound examinations (mean [SD] patient age, 9.9 [4.2] years; 5392 [58.2%] boys) performed by 31 sonographers (mean number examinations, 299 [139]; range, 115–610) and interpreted by 31 radiologists (mean number examinations, 299 [157]; range, 101–845) were included. The mean frequency of appendix visualization per sonographer was 57.8% [8.7%] (range, 40.9–76.0%) and per radiologist was 59.5% [4.1%] (range, 51.7–66.3%). The mean rate of CT utilization per sonographer was 9.2% [2.0%] (range, 5.9–14.0%) and per radiologist was 9.2% [1.8%] (range, 3.4–12.1%). Predictors of appendix visualization by ultrasound included patient weight (p < 0.0001), sex (p = 0.0003), white blood cell count (p < 0.0001), temperature (p = 0.002), abdominal tenderness (p = 0.004), presence of appendicitis (p < 0.0001), sonographer (p < 0.0001), and radiologist (p = 0.02). Predictors of CT utilization included patient weight (p < 0.0001), white blood cell count (p < 0.0001), abdominal tenderness (p < 0.0001), rebound tenderness (p = 0.0003), and presence of appendicitis (p < 0.0001), but not sonographer or radiologist.

Conclusion

Individual sonographers and radiologists were associated with appendix visualization by ultrasound in children with suspected acute appendicitis; neither was associated with CT utilization.

Key Points

• Individual sonographers and radiologists are significantly and independently associated with appendix visualization by ultrasound in children with suspected acute appendicitis.

• Frequency of appendix visualization per sonographer demonstrated significant and wide variability across 31 sonographers, ranging from 40.9 to 76.0%.

• Fewer than 10% of patients with an ultrasound examination for suspected acute appendicitis underwent CT imaging within the following 24 h. Individual radiologists and sonographers were not predictive of CT utilization within 24 h.

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Abbreviations

CT:

Computed tomography

EMR:

Electronic medical record

MRI:

Magnetic resonance imaging

OR:

Odds ratio

PACS:

Picture Archiving and Communication System

RIS:

Radiology information system

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Acknowledgements

We would like to acknowledge the Division of Biomedical Informatics at Cincinnati Children’s Hospital Medical Center, which provided in-kind support in the form of data collection. Research data services provided by the Division of Biomedical Informatics are partially supported by the Center for Clinical & Translational Science & Training (CCTST). This project was supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number 5UL1TR001425-03. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Leah A. Gilligan, Andrew T. Trout, Sara M. O’Hara & Jonathan R. Dillman

  2. Department of Radiology, Northwestern Memorial Hospital, 676 N St Clair St, IL, 60611, Chicago, USA

    Leah A. Gilligan

  3. Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Andrew T. Trout, Sara M. O’Hara & Jonathan R. Dillman

  4. Department of Radiology, Michigan Medicine, Ann Arbor, MI, USA

    Matthew S. Davenport

  5. Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Bin Zhang

  6. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Bin Zhang

Authors
  1. Leah A. Gilligan
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  2. Andrew T. Trout
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  3. Matthew S. Davenport
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  4. Bin Zhang
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  5. Sara M. O’Hara
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  6. Jonathan R. Dillman
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Corresponding author

Correspondence to Leah A. Gilligan.

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Guarantor

The scientific guarantor of this publication is Jonathan Dillman, MD, MSc.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Bin Zhang, PhD kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective,

• observational,

• single institution

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Gilligan, L.A., Trout, A.T., Davenport, M.S. et al. Variation in imaging outcomes associated with individual sonographers and radiologists in pediatric acute appendicitis: a retrospective cohort of 9271 examinations. Eur Radiol 31, 8565–8577 (2021). https://doi.org/10.1007/s00330-021-07939-1

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  • DOI: https://doi.org/10.1007/s00330-021-07939-1

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