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Protocol for suspected pediatric appendicitis limits computed tomography utilization.

Amy E Wagenaar1, Jun Tashiro1, Bo Wang1

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Summary
This summary is machine-generated.

Implementing an ultrasound-first protocol significantly reduced computed tomography (CT) use for pediatric appendicitis, lowering radiation exposure and costs. This approach enhances diagnostic efficiency while prioritizing patient safety in children

Keywords:
AppendicitisComputed tomographyPediatricsProtocolUltrasound

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Area of Science:

  • Pediatric Imaging
  • Abdominal Imaging
  • Diagnostic Accuracy

Background:

  • Computed tomography (CT) is frequently used for diagnosing appendicitis in children, despite concerns regarding radiation exposure.
  • There is a need for alternative imaging strategies to minimize radiation risks in pediatric patients.
  • Ultrasound (US) offers a radiation-free imaging option for evaluating suspected appendicitis.

Purpose of the Study:

  • To decrease the utilization of CT scans for diagnosing appendicitis in a pediatric hospital setting.
  • To implement and evaluate an algorithm prioritizing a 24-hour ultrasound (US) as the primary imaging modality.
  • To assess the impact of the US-first protocol on imaging utilization, radiation exposure, and healthcare costs.

Main Methods:

  • An ultrasound-based protocol for suspected appendicitis was adopted, with data collected for 12 months prior and 24 months after implementation.
  • Imaging test usage and associated charges were analyzed, adjusted per annual appendectomy numbers.
  • Continuous training for emergency department staff was provided for over one year post-implementation.

Main Results:

  • CT utilization decreased by 42% from FY 2011 to FY 2013 (2.43 to 1.40 CTs per appendectomy).
  • Ultrasound use increased by 27% after protocol implementation (4.11 to 5.20 US per appendectomy).
  • Average length of hospital stay decreased (2.57 days to 2.15 days), and imaging-related charges per appendectomy were significantly reduced.

Conclusions:

  • A protocol-driven workup prioritizing ultrasound significantly reduces CT utilization and radiation exposure in children with suspected appendicitis.
  • This strategy also leads to a notable decrease in imaging-related healthcare costs.
  • Sustained staff training is crucial for ensuring consistent protocol adherence and maximizing benefits.