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Costs and effectiveness of ultrasonography and limited computed tomography for diagnosing appendicitis in children

B M Peña1, G A Taylor, S J Fishman

  • 1Department of Medicine, Division of Emergency Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA. pena_b@a1.tch.harvard.edu

Pediatrics
|October 4, 2000
PubMed

Insights

This study shows that using ultrasonography (US) followed by computed tomography with rectal contrast (CTRC) significantly improves management decisions and saves costs for pediatric appendicitis diagnosis. The protocol led to beneficial changes in 61.9% of cases and reduced costs by $565 per patient.

Area of Science:

  • Pediatric Radiology
  • Diagnostic Imaging
  • Abdominal Imaging

Background:

  • Acute appendicitis is a common surgical emergency in children.
  • Accurate diagnosis is crucial to avoid complications and unnecessary surgery.
  • A protocol combining ultrasonography (US) and computed tomography with rectal contrast (CTRC) has shown high diagnostic accuracy.

Purpose of the Study:

  • To evaluate the impact of a combined US and CTRC protocol on patient management and healthcare costs in pediatric appendicitis.
  • To assess the effectiveness of this diagnostic pathway in a real-world clinical setting.

Main Methods:

  • Prospective cohort study involving 139 children (3-21 years) with equivocal clinical findings for appendicitis.
  • Children underwent US; those with negative/equivocal results proceeded to CTRC.
  • Surgical management plans and hospital costs were analyzed before and after imaging.

Main Results:

  • The US followed by CTRC protocol led to a beneficial change in management for 61.9% of children.
  • Compared to US alone (38.7% beneficial change), the combined protocol improved decision-making (68.5% beneficial change).
  • The protocol resulted in significant cost savings of $565 per patient, totaling $78,503.99.

Conclusions:

  • The US followed by CTRC protocol is effective in guiding management for pediatric appendicitis with equivocal presentations.
  • This imaging strategy optimizes patient care and achieves substantial cost savings.
  • The protocol offers a high rate of beneficial management changes and economic advantages.
Abstract

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