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Clinical practice guidelines for pediatric appendicitis evaluation can decrease computed tomography utilization while

W Scott Russell1, Abigail M Schuh, Jeanne G Hill

  • 1Division of Pediatric Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA. mail: ruscott@musc.edu

Pediatric Emergency Care
|April 25, 2013
PubMed

Insights

Implementing a new guideline for appendicitis evaluation in children significantly reduced computed tomography (CT) scan use by 41%. This change improved imaging efficiency without impacting diagnostic accuracy or negative appendectomy rates.

Area of Science:

  • Pediatric emergency medicine
  • Radiology
  • Surgical outcomes

Background:

  • Computed tomography (CT) scans are frequently used for diagnosing appendicitis in children.
  • Overutilization of CT scans raises concerns regarding radiation exposure and healthcare costs.

Purpose of the Study:

  • To evaluate the impact of a clinical practice guideline on CT scan utilization for pediatric appendicitis.
  • To assess changes in diagnostic accuracy and negative appendectomy rates after guideline implementation.

Main Methods:

  • A multidisciplinary team developed a clinical pathway for pediatric abdominal pain evaluation.
  • CT scan utilization rates were compared before and after the guideline's implementation.

Main Results:

  • CT scan use for appendectomy patients decreased by 41% post-guideline implementation.
  • The negative appendectomy rate remained stable (5.7% pre- vs. 5.2% post-implementation).
  • CT use in patients transferred from outside hospitals decreased by 76%.

Conclusions:

  • A clinical pathway emphasizing early surgical consultation and ultrasound can significantly reduce CT scan reliance for pediatric appendicitis.
  • This approach maintains diagnostic accuracy and avoids an increase in negative appendectomies.
Abstract

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