P1.091: Evolving Management in Pediatric Appendicitis: A 14-Year Review of Ketorolac, Opioid Use, and Imaging Trends

Background: Acute appendicitis is a common pediatric emergency requiring timely diagnosis and effective pain management. This study evaluates trends in ketorolac use, opioid prescribing, and imaging modalities in pediatric appendicitis cases, addressing concerns about ketorolac’s role in diagnostic accuracy and opioid reduction.

Methods: A retrospective analysis of 2,294 pediatric emergency department (ED) visits for suspected appendicitis from 2010 to 2023 was conducted. Data included administration of ketorolac, opioids, and non-opioid analgesics, as well as imaging use (ultrasound [US] vs. computed tomography [CT]). Statistical analyses included Pearson correlation and chi-square tests.

Results: Ketorolac use increased significantly from 1.5% in 2010 to 18.4% in 2023 (r = 0.89, p < 0.001), while opioid use declined from 50.3% in 2013 to 19.4% in 2023 (r = -0.93, p < 0.001). Non-opioid analgesic use rose concurrently (r = 0.90, p < 0.001). Imaging trends shifted toward increased ultrasound use (r = 0.93, p < 0.001) and decreased CT use (r = -0.92, p < 0.001). CT yielded more positive diagnoses (88.7%) than US (51.6%). Among patients who received ketorolac, there was no difference in intraoperative blood loss.

Conclusion: From 2010 to 2023, pediatric ED care for suspected appendicitis shifted toward safer, less invasive practices. Ketorolac use rose without compromising surgical safety, while opioid use and CT imaging declined.