Related Experiment Videos
Effect of an imaging protocol on clinical outcomes among pediatric patients with appendicitis
Barbara M Garcia Peña1, George A Taylor, Steven J Fishman
1Department of Emergency Medicine, Miami Children's Hospital, Miami, Florida 33155, USA. barbara.pena@mch.com
Insights
Implementing an imaging protocol of ultrasonography (US) followed by computed tomography (CT) significantly reduced perforation and negative appendectomy rates in children with appendicitis.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
Background:
- Appendicitis is a common surgical emergency in children.
- Accurate diagnosis is crucial to avoid unnecessary surgeries and complications like perforation.
- Previous diagnostic methods had limitations in specificity and sensitivity.
Purpose of the Study:
- To evaluate the impact of a combined ultrasonography (US) and computed tomography (CT) imaging protocol on perforation and negative appendectomy rates in children with suspected appendicitis.
- To assess the effectiveness of the protocol in improving diagnostic accuracy and patient outcomes.
Main Methods:
- A modified time series design was used, analyzing prospective and retrospective cohorts of children admitted for suspected appendicitis.
- The study compared perforation and negative appendectomy rates before and after the implementation of the US-CT protocol in 1998.
- Statistical adjustments were made for secular time trends.
Main Results:
- The study identified 1338 children, with 810 (60.5%) presenting with equivocal findings.
- Post-protocol implementation, the perforation rate decreased from 35.4% to 15.5%.
- The negative appendectomy rate also significantly decreased from 14.7% to 4.1% after protocol adoption.
Conclusions:
- The integrated US-CT imaging protocol led to a substantial reduction in both perforation and negative appendectomy rates in pediatric appendicitis cases.
- This protocol demonstrates improved diagnostic efficacy and patient management for suspected appendicitis in children.
Objective:
In 1998, we implemented a clinical imaging protocol in which children with suspected appendicitis underwent ultrasonography (US) followed by computed tomography (CT). We sought to determine the impact of the US-CT protocol on changes in perforation and negative appendectomy rates.
Methods:
Children with unequivocal presentations for appendicitis went to the operating room without entering the imaging protocol. Using a modified time series design, we analyzed a prospective and retrospective cohort of consecutive patients who were admitted from the emergency department for suspected appendicitis. The perforation and negative appendectomy rates were computed for the periods before and after implementation of the imaging protocol and adjustment for time trends was made.
Results:
A total of 1338 children were identified. Eight hundred ten (60.5%) children had equivocal clinical findings. A total of 920 patients were admitted for suspected appendicitis before the protocol was implemented; 526 (57.2%) of the 920 children had appendicitis, and 186 (35.4%) of them had perforation. A total of 91 (14.7%) of 617 had negative appendectomies. After the protocol was implemented, 418 patients were admitted for suspected appendicitis; 328 (78.5%) had appendicitis with 51 (15.5%) perforated. There were 14 (4.1%) of 342 cases of negative appendectomies. After implementation of the imaging protocol, the perforation rate decreased from 35.4% to 15.5%, and the negative appendectomy rate decreased from 14.7% to 4.1%. After secular time trends were adjusted for, the imaging protocol continued to have a strong association with a reduction in perforation rate and negative appendectomy rate.
Conclusion:
The implementation of an imaging protocol using US and CT resulted in a marked decrease in the perforation and negative appendectomy rates in children with suspected appendicitis.