Risk Stratification to Decrease Unnecessary Diagnostic Imaging for Acute Appendicitis

Area of Science:

• Pediatric emergency medicine
• Diagnostic imaging optimization
• Clinical decision support systems

Background:

• Increasing use of imaging for appendicitis diagnosis, despite identification of high/low-risk pediatric groups who may not benefit.
• Need for improved diagnostic workup to reduce unnecessary imaging in pediatric appendicitis.

Purpose of the Study:

• To evaluate the impact of a standardized care pathway and an electronic decision support tool on diagnostic imaging for appendicitis in children.
• To determine if these interventions could safely decrease the use of unnecessary imaging compared to historical controls.

Main Methods:

• Interrupted time series trial comparing diagnostic imaging (CT and ultrasound) proportions across three periods: historical controls, passive pathway diffusion, and active electronic decision support tool.
• Analysis focused on changes in imaging utilization within moderate- and high-risk pediatric appendicitis groups.

Main Results:

• Both passive and active interventions significantly reduced computed tomography (CT) use in moderate- and high-risk groups compared to historical controls.
• Ultrasound utilization increased across all risk groups after the interventions.
• Time series analysis indicated that secular trends did not explain the observed decrease in CT use.

Conclusions:

• Passive and active decision support tools effectively minimized unnecessary CT imaging for pediatric appendicitis.
• Further long-term studies are needed to fully understand the sustained effects of these interventions.