Regional transfer of children with appendix-related concerns to outside cross-sectional imaging

Objectives: Diagnostic discordance between general and pediatric radiologists with respect to abdominal computed tomography (CT) and magnetic resonance imaging (MRI) is established, particularly with respect to acute appendicitis. In this study, we aimed to identify the negative pediatric radiologist interpretation rate among patients transferred to our institution for appendix-related concerns. Material and Methods: We retrospectively reviewed all children transferred from statewide outside facilities to our standalone tertiary care children’s hospital from June 2018 to July 2023 for appendix-related concerns. Results: Out of 1041 appendix-related transfers during the 5-year study period, 889 had outside abdominal CT or MRI. Of this cohort, 103 (11.6%) patients had a negative interpretation by pediatric radiologists. Thirty-nine patients (37.9%) were given pre-transfer antibiotics, primarily due to concern for appendicitis (92.3%). Other acute findings noted on pediatric radiologist review included a thickened bladder and increased stool burden. Additional imaging was performed post-transfer in 30 (29.1%) patients as follows: Appendix ultrasound (US) (60%), abdomen US (3.3%), right upper quadrant US (13.3%), testicular US (3.3%), and pelvic US (43.3%). Sixty-seven (65%) patients were discharged home from the emergency department with the remainder admitted. The median (Q1, Q3) length of stay at our institution was 6.9 (4.2, 16.2) h. Only one patient underwent post-discharge appendectomy. Conclusion: During the study period, 11.6% of transferred patients with outside CT/MRI had negative interpretations by our pediatric radiologists. Despite barriers, teleradiology has the potential to transform appendix-related transfers by enabling diagnostic clarity. The financial and social burdens incurred by potentially avoidable transfers could be significant, warranting further investigation.