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A simple algorithm to improve quality while reducing resource utilization in evaluation of suspected appendicitis in

Joseph R Esparaz1, Greg C McGovern1, Alyssa R Mowrer1

  • 1Department of Surgery, University of Illinois College of Medicine, Peoria, IL, USA.

American Journal of Surgery
|November 21, 2018
PubMed

Insights

To reduce overuse of ultrasound for pediatric appendicitis diagnosis, a white blood cell (WBC) count of 10,000/μL was identified as a key criterion. Implementing this could decrease ultrasound use by nearly 50%.

Area of Science:

  • Pediatric Radiology
  • Diagnostic Imaging
  • Emergency Medicine

Background:

  • Institution replaced CT scans with ultrasound for pediatric appendicitis diagnosis due to similar effectiveness.
  • Overutilization of ultrasound became an unintended consequence.
  • Need to establish measures to prevent ultrasound overuse.

Purpose of the Study:

  • To identify measures to prevent the overuse of ultrasound in diagnosing appendicitis in children.
  • To establish criteria for appropriate ultrasound utilization.

Main Methods:

  • Retrospective chart review of 327 pediatric patients evaluated for appendicitis.
  • Analysis of clinical, radiographic, and histopathologic findings.
  • Determination of diagnostic accuracy of ultrasound (US) and white blood cell (WBC) values.
  • Development of a management algorithm.

Main Results:

  • All 327 patients underwent ultrasound for suspected appendicitis.
  • A WBC count of ≥10,000/μL was identified as a primary discriminant for management and US utilization.
  • Utilizing WBC count ≥10,000/μL as a criterion could have reduced US utilization by 49.5%.

Conclusions:

  • Clinical examination, WBC count, and surgical consultation can reduce the need for ultrasound in pediatric appendicitis.
  • Implementing a WBC count threshold can significantly decrease unnecessary ultrasound examinations.
  • Optimizing diagnostic pathways improves resource allocation in pediatric imaging.
Abstract

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