Suspected appendicitis pathway continues to lower CT rates in children two years after implementation

Area of Science:

• Pediatric Imaging
• Diagnostic Pathways
• Appendicitis Management

Background:

• Appendicitis is a common surgical emergency in children.
• Computed tomography (CT) has been widely used for diagnosing appendicitis in pediatric patients.
• Concerns exist regarding radiation exposure and cost associated with pediatric CT scans.

Purpose of the Study:

• To evaluate the impact of a new protocol on CT utilization and diagnostic accuracy for suspected appendicitis in pediatric patients.
• To assess the long-term trends in CT use after protocol implementation.
• To determine the adherence rate to the new imaging pathway.

Main Methods:

• Retrospective observational study of pediatric patients (<18 years) with suspected appendicitis.
• Comparison of CT utilization rates before and after the implementation of an ultrasound-first protocol.
• Analysis of monthly CT rates using linear regression to identify trends.
• Calculation of adherence to the protocol and negative appendectomy rates.

Main Results:

• CT utilization decreased significantly from 94.2% to 27.5% after protocol implementation (p < 0.001).
• Monthly CT rates showed a continued downward trend for two years post-implementation.
• Adherence to the ultrasound-first pathway was high at 89.8%.
• The negative appendectomy rate in the post-pathway period was 2.4%.

Conclusions:

• Adherence to an ultrasound-first imaging protocol effectively reduces CT use in pediatric appendicitis evaluations.
• The implemented pathway leads to sustained decreased CT utilization without compromising diagnostic accuracy.
• This approach offers a safer and potentially more cost-effective method for diagnosing appendicitis in children.