Suspected appendicitis pathway continues to lower CT rates in children two years after implementation - 26/09/19
, Samuel D. Smith a, Melvin S. Dassinger a, Jeffrey M. Burford a, Joseph J. Tepas b, Marie Crandall bAbstract |
Background |
We implemented a protocol to evaluate pediatric patients with suspected appendicitis using ultrasound as the initial imaging modality. CT utilization rates and diagnostic accuracy were evaluated two years after pathway implementation.
Methods |
This was a retrospective observational study of patients <18 years evaluated for suspected appendicitis. CT rates were compared before and after implementation of the protocol, and monthly CT rates were calculated to assess trends in CT utilization.
Results |
CT use decreased significantly following pathway implementation from 94.2% (130/138) to 27.5% (78/284; p < 0.001). Linear regression of monthly CT utilization demonstrated that CT rates continued to trend down two years after pathway implementation. Adherence to the pathway was 89.8% (255/284). Negative appendectomy rate was 2.4% (2/85) in the post-pathway period.
Conclusions |
Adherence to a pathway designed to evaluate pediatric patients with suspected appendicitis using ultrasound as the primary imaging modality has led to a sustained decrease in CT use without compromising diagnostic accuracy.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Protocol using ultrasound initially to evaluate suspected appendicitis in children. |
• | Comparison of CT rates and diagnostic accuracy in pre- and post-pathway periods. |
• | High adherence to pathway with significant sustained reduction in CT utilization. |
• | Diagnostic accuracy improved with a decrease in negative appendectomy rates. |
• | Institutional pathways require ongoing assessment of their long-term impact. |
Résumé |
Adherence to a pathway designed to evaluate pediatric patients with suspected appendicitis using ultrasound as the primary imaging modality has led to a sustained decrease in computed tomography use without compromising diagnostic accuracy. Continued adherence to and effectiveness of a voluntary pathway that relies on safe imaging is reassuring and highlights the importance of ongoing assessment of the long-term impact of an institution's pathways.
Le texte complet de cet article est disponible en PDF.Keywords : Appendicitis, Computed tomography, Negative appendectomy rates, Pathway, Pediatric, Ultrasound
Plan
Vol 218 - N° 4
P. 716-721 - octobre 2019 Retour au numéro
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