Document Type

Conference Proceeding

Publication Date

4-2026

Abstract

Background: Obesity may complicate clinical assessment and ultrasound (US) evaluation in children with appendicitis, potentially increasing reliance on computed tomography (CT). At the same time, national pediatric quality-improvement initiatives and ALARA-driven imaging pathways emphasize reducing CT use and promoting US-first approaches. Data examining how body mass index (BMI) influences diagnostic pathways within these modern low-radiation protocols are limited.

Objective: To determine whether higher BMI is associated with greater CT utilization, escalation from US to CT, nondiagnostic US examinations, emergency department (ED) length of stay (ED-LOS), and operative duration in children with appendicitis.

Design/Methods: This retrospective cohort study included patients < 18 years with surgically confirmed appendicitis presenting to a tertiary pediatric ED from January 1, 2010, to December 31, 2023. Consistent with prior dataset methodology, encounters were identified through structured EHR query using ICD-10 and CPT codes and restricted to unique first visits. A total of 2,275 children were included; BMI was available for 2,012 (88%). BMI was analyzed in quartiles. Imaging modality (US-only, CT-only, or CT after US) and operative duration (proxy for case complexity) were evaluated. χ² and Wilcoxon tests and odds ratios (OR) with 95% CI were used. IRB approval was obtained (Corewell Health IRB No. 2024-128).

Results: Children in the highest BMI quartile had higher CT utilization than those in the lowest quartile (35.6% vs 24.7%; OR 1.69, 95% CI 1.29-2.22) and more frequent escalation from US to CT (43.3% vs 25.8%; OR 2.20, 95% CI 1.39-3.48). Nondiagnostic US exams were more common with higher BMI (7.4% vs 4.2%). Operative duration was longer in the highest BMI group (median 49.0 vs 40.5 minutes; p< 0.05). ED-LOS was similar (5.68 vs 5.50 hours; p=0.77). Negative appendectomy rates did not differ.

Conclusion(s): Higher BMI in pediatric appendicitis is associated with increased CT use, greater escalation after US, higher nondiagnostic US rates, and longer operative duration. As national QI initiatives emphasize ultrasound-first algorithms and CT reduction, these findings highlight the need for BMI-informed imaging strategies and early surgical involvement to support equitable, efficient, and radiation-sparing care.

Comments

97th Pediatric Academic Societies (PAS) Meeting, April 24-27, 2026, Boston, MA

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