P1.079: Radiologic Interpretations of Computed Tomography (CT) Scans Evaluating Abdominal Pain Associated with Preventable Transfers: A Content Analysis

Background: Despite known risks associated with radiation exposure in children, the use of computed tomography (CT) scans during the initial evaluation of pediatric patients with abdominal pain remains prevalent at non-pediatric-specialized centers. Due to increasing regionalization of pediatric-specialized care, children are frequently transferred for surgical evaluation, particularly for concerns for intra-abdominal pathology on CT or due to persistent pain despite normal imaging findings. We sought to determine common categories of radiologic findings associated with preventable transfers (PVTs) among children presenting with abdominal pain who underwent CT at a referring facility.

Methods: We performed a single-institution retrospective cohort study between 05/2022 and 04/2024. Patients 18 years old transferred to a pediatric hospital system for evaluation of abdominal pain were included. Transfers were deemed non-preventable (nPVTs) if the patient required transfer for specialty imaging unavailable at the referring facility, or admission or operative/procedural intervention. All others were deemed PVTs. We performed a qualitative content analysis of radiologic interpretations for PVTs who underwent CT at a referring facility. Reads were compared to overreads performed by a pediatric radiologist to determine common interpretative categories associated with PVTs. Bivariate analysis was performed to compare read discordance between PVTs and nPVTs.

Results: We included 115 PVTs, with median age 9 years (IQR 6,14) and male predominance (59%) (Table 1). No acute findings were identified on pediatric-specialized radiologist overread of referring center CT in 46% of patients. Concern for appendicitis was the most common category of referring center radiologic interpretations, seen in 47% (n=54) of patients, with borderline dilation or equivocal for appendicitis described in 57% (n=31). Diarrheal illness, enteritis, colitis or ileus was the second most common interpretative category (28%), followed by constipation or stool burden (12%), mesenteric adenitis (9%) and hepatobiliary process (7%). Discordance between referring center interpretation and tertiary center overread was seen in 60% of patients overall, most commonly in the concern for appendicitis group (n=41, 76%) and particularly within the subgroup borderline dilation or equivocal for appendicitis (n=26, 84%) (Figure 1). Prevalence of discordant CT interpretation among patients who had concern for appendicitis varied between nPVT and PVT groups (0% vs 76%, p < 0.001).

Conclusion: Almost one-half of pediatric patients transferred for evaluation of abdominal pain after undergoing CT imaging at a referring facility had no acute findings on subsequent overread at a pediatric-specialized center. High rates of discordance between referring center radiologic interpretation and overread following transfer were seen, most commonly with concern for acute appendicitis with borderline dilation or equivocal imaging. These findings suggest an opportunity for centralized pediatric radiology services or interfacility telemedicine with multidisciplinary pediatric-specialized radiologic and surgical provider review in patients with indeterminant imaging to decrease rates of preventable transfer.