PEDIATRICS/ORIGINAL RESEARCH Increasing Computed Tomography Use for Patients With Appendicitis and Discrepancies in Pain Management Between Adults and Children: An Analysis of the NHAMCS Daniel S. Tsze, MD, MPH, Lisa M. Asnis, ScM, Roland C. Merchant, MD, MPH, Siraj Amanullah, MD, MPH, James G. Linakis, PhD, MD From the Department of Pediatrics, Division of Pediatric Emergency Medicine (Tsze, Amanullah, Linakis) and the Department of Emergency Medicine (Tsze, Merchant, Amanullah, Linakis), Warren Alpert Medical School of Brown University, Providence, RI; and the Department of Community Health, Brown University, Providence, RI (Asnis, Merchant). Study objective: Using a national sample of emergency department (ED) visits, we aim to describe use of CBC, computed tomography (CT), and pain medication among ED visits in which appendicitis was diagnosed. We describe use trends over time and identify use differences between adults and children. Methods: The ED component of the National Hospital Ambulatory Medical Care Survey was analyzed for 1992 through 2006, comprising a sample of 447,011 visits (representing an estimated total of approximately 1.5 billion visits), from which a sample of 1,088 patients (representing an estimated 3.7 million patients) received a diagnosis of appendicitis. The frequency of CBC and CT use and frequency of pain medication administration were determined. Survey-adjusted regression analyses were used to determine the probability of a patient receiving CBC, CT, or pain medication. Use was compared between adults and children. Results: During the course of the study, from 1996 to 2006, the percentage of patients with appendicitis who received a CT scan increased from 6.3% (95% confidence interval [CI] 0% to 15.3%) to 69% (95% CI 55.5% to 81.7%) for adults and from 0% to 59.8% (95% CI 31.6% to 87.9%) for children. CBC use for adults increased from 77.2% (95% CI 62.9% to 91.5%) to 92.8% (95% CI 85.8% to 99.7%) and decreased from 89.1% (95% CI 74.9% to 100.0%) to 68.4% (95% CI 41.9% to 94.9%) for children. The use of pain medications increased from 24.8% (95% CI 11.3% to 38.4%) to 69.9% (95% CI 56.7% to 83.1%) for adults and from 27.2% (95% CI 5.7% to 48.8%) to 42.8% (95% CI 18.1% to 67.5%) for children. The proportion of children who received parenteral narcotics (13.7% [95% CI 9.3% to 18.0%]) was less than that of adults (23% [95% CI 18.9% to 27.1%]). Conclusion: CT use has increased for patients with appendicitis over time, and CBC use remains high. There has been an increase in analgesic administration, but more than half of all patients with appendicitis had not received pain medication over the course of the entire study period. Children received fewer parenteral narcotics than adults and appeared to be preferentially treated with nonparenteral nonnarcotic analgesics. [Ann Emerg Med. 2012;59:395-403.] Please see page 396 for the Editor’s Capsule Summary of this article. Provide feedback on this article at the journal’s Web site, www.annemergmed.com. A podcast for this article is available at www.annemergmed.com. 0196-0644/$-see front matter Copyright © 2011 by the American College of Emergency Physicians. doi:10.1016/j.annemergmed.2011.06.010 INTRODUCTION Background Appendicitis is one of the most common causes of acute abdominal pain requiring surgery. 1,2 Although CBCs and computed tomography (CT) scans are often used in the evaluation of appendicitis in emergency departments (EDs), there is much variation in how they are used. 3-17 There is also debate about the value of CBCs in diagnosing appendicitis 3,4,6,7,9,12,18-22 and the best choice of diagnostic imaging 23-25 to minimize complications, radiation, unnecessary testing, and surgery. 21-23 It is likely that CT usage in the ED has increased pursuant to research demonstrating its superiority over physical examination and history alone in diagnosing appendicitis. 26 The challenges of using physical examination and history alone are particularly evident when pediatric patients are evaluated. 5 ED clinicians are also responsible for managing the pain associated with appendicitis. Some research suggests that ED Volume , .  : May  Annals of Emergency Medicine 395