Imaging decision-making in suspected appendicitis in Thailand: A national cross-specialty survey with system-level analysis.

OBJECTIVES

To characterize imaging practice patterns, diagnostic confidence, and opinion gaps regarding suspected appendicitis using a national, cross-specialty survey.

METHODS

A four-part, 79-item online questionnaire was developed and validated with excellent content validity (scale-level CVI = 0.9375; item-level CVI = 0.9794) and strong internal consistency (Cronbach's α = 0.874). The survey assessed respondent demographics, imaging strategies across clinical scenarios, radiologists' technique preferences, and non-radiologists' perspectives, and was distributed nationally in June 2024. Twenty-four clinically relevant Likert-scale opinion items were analyzed using principal component analysis. Sampling adequacy (KMO = 0.649) and factorability (Bartlett's test, p < 0.001) were confirmed. Components were retained based on eigenvalues >1.0 and interpreted using loadings >0.50. Component scores were compared across subgroups.

RESULTS

Among 128 respondents, most were specialists (89.8%), radiologists (74.2%), and practiced in non-training hospitals (57.8%). CT was the most frequently used imaging modality for suspected appendicitis (79.7%), followed by ultrasound (69.5%). Confidence in positive ultrasound findings was comparable between radiologists and non-radiologists, whereas radiologists reported greater confidence in CT interpretation and lower confidence in MRI than non-radiologists receiving reports. Imaging preferences differed across clinical contexts, particularly in low-suspicion cases, special populations, and following inconclusive ultrasound. Institutional factors, including hospital training status and MRI availability, were consistently associated with variations in imaging opinions and confidence.

CONCLUSION

Imaging practices and diagnostic confidence for suspected appendicitis varied substantially across specialties and institutions. Targeted education, improved access to expertise, and clearer interdisciplinary guidance may help harmonize imaging strategies and promote more consistent, evidence-based care.