Computed Tomography Utilization for the Diagnosis of Acute Appendicitis in Children Decreases With a Diagnostic Algorithm

被引:29
|
作者
Shah, Sohail R. [1 ]
Sinclair, Kelly A. [2 ]
Theut, Stephanie B. [3 ]
Johnson, Kathy M. [4 ]
Holcomb, George W., III [4 ]
St Peter, Shawn D. [4 ]
机构
[1] Texas Childrens Hosp, Baylor Coll Med, Div Pediat Surg, Houston, TX 77030 USA
[2] Childrens Mercy Hosp, Div Emergency Med & Urgent Care, Kansas City, MO 64108 USA
[3] Childrens Mercy Hosp, Dept Radiol, Kansas City, MO 64108 USA
[4] Childrens Mercy Hosp, Div Gen & Thorac Surg, Kansas City, MO 64108 USA
关键词
appendicitis; children; pediatric surgery; ultrasound; PEDIATRIC APPENDICITIS; SUSPECTED APPENDICITIS; PROSPECTIVE VALIDATION; RADIATION-EXPOSURE; ULTRASONOGRAPHY; MANAGEMENT; SCORE; CT; PERSPECTIVE; ULTRASOUND;
D O I
10.1097/SLA.0000000000001867
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: The primary objective of this project was to decrease computed tomography (CT) utilization for the diagnosis of appendicitis in an academic children's hospital emergency department (ED) through a multidisciplinary quality improvement initiative. Background: Appendicitis is the most common abdominal diagnosis leading to the hospitalization of children in the United States. However, the diagnosis of appendicitis in children can be difficult and many centers rely heavily upon CT scans. Recent recommendations emphasize decreasing CT use among pediatric patients because of an increased lifetime risk of radiation-induced malignancies. Methods: A retrospective review was conducted of patients diagnosed with appendicitis in the ED at Children's Mercy Hospital from January 1, 2011 to February 28, 2014 to establish a baseline cohort. From August 1, 2014 to July 31, 2015, a newly designed diagnostic algorithm was used in the ED and patients were prospectively followed. Any patient discharged from the ED received a follow-up phone call. Patients treated for appendicitis before and after pathway implementation were compared. In addition, any patient evaluated for appendicitis after implementation of the algorithm was analyzed for adherence to the clinical pathway. Differences between the 2 groups were analyzed using ANOVA, Wilcoxon Rank Sum, chi(2), and Fisher Exact tests. Results: Of 840 patients seen after implementation of the diagnostic algorithm, 267 were diagnosed with appendicitis. After implementation of the algorithm, CT utilization decreased from 75.4% to 24.2% (P < 0.0001) in patients with appendicitis. CT utilization was 27.3% after implementation, regardless of the ultimate diagnosis or algorithm adherence. The diagnostic pathway had a sensitivity of 98.6% and specificity of 94.4%. Conclusions: Implementation of a diagnostic algorithm for appendicitis in children significantly decreases CT utilization, whereas maintaining a high sensitivity and specificity.
引用
收藏
页码:474 / 481
页数:8
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