Related Experiment Video
Updated: Nov 15, 2025
Author Spotlight: Developing a Bedside Protocol for Kidney and Genitourinary Ultrasonography
Published on: June 21, 2024
Emergency Department Point-of-Care Ultrasonography Can Reduce Length of Stay in Pediatric Appendicitis: A
Kathryn E Kasmire1, Joshua Davis1
1Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
Insights
Point-of-care ultrasonography (POCUS) significantly reduces length-of-stay and imaging costs for suspected pediatric appendicitis. This approach offers a more efficient diagnostic pathway for children presenting with appendicitis symptoms.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Surgical Emergencies
Background:
- Appendicitis is a leading cause of emergency surgery in children.
- Current imaging protocols often involve advanced modalities after initial ultrasonography.
- Optimizing diagnostic pathways is crucial for efficient pediatric care.
Purpose of the Study:
- To evaluate the impact of point-of-care ultrasonography (POCUS) on healthcare costs and length-of-stay (LOS) in pediatric appendicitis.
- To compare POCUS as a primary imaging tool versus traditional advanced imaging methods.
Main Methods:
- A retrospective chart review was conducted on pediatric patients presenting with suspected appendicitis.
- Costs and LOS were compared between patients who received POCUS and those who underwent magnetic resonance imaging (MRI) as initial imaging.
- Data were collected from August 2017 to June 2019.
Main Results:
- Patients receiving POCUS had a significantly shorter mean ED length-of-stay (274 minutes) compared to those without (317 minutes).
- Average imaging costs were lower with POCUS ($1308) versus MRI ($1371), with combined POCUS and MRI being most expensive ($2010).
- The POCUS group was younger and less likely to be admitted or have confirmed appendicitis.
Conclusions:
- Point-of-care ultrasonography is effective in reducing length-of-stay and imaging expenses for pediatric appendicitis.
- Further research is needed to identify optimal patient selection for POCUS and its broader applicability.
Objectives:
Appendicitis is the most common pediatric surgical emergency. Ultrasonography is recommended as first-line imaging for appendicitis in children; however, this is often followed by more advanced imaging. Our goal was to determine if point-of-care ultrasonography (POCUS) could reduce cost and length-of-stay (LOS) in suspected pediatric appendicitis.
Methods:
We performed a chart review of patients presenting to our pediatric emergency department (ED) from August 1, 2017 to June 30, 2019 who had imaging for appendicitis. We compared cost and LOS for patients who received POCUS to those who had magnetic resonance imaging (MRI) as first-line imaging, which is standard at our institution.
Results:
We identified 695 visits of 685 unique patients. Patients who received POCUS (n = 209) had a significantly shorter mean LOS (274 minutes) in the ED compared to patients who did not (317 minutes, P <.001). This was true regardless of the month of their visit. The POCUS group was younger, less likely to have right lower quadrant pain/tenderness, less likely to be admitted, and less likely to have appendicitis than the MRI group. Average appendix imaging cost per patient was lower in the POCUS group at $1308 compared to the MRI group at $1371 (P <.001), although patients who had both POCUS and MRI (n = 102) had the highest average imaging costs ($2010).
Conclusion:
POCUS can reduce LOS and imaging cost in suspected pediatric appendicitis. Further study is warranted to determine which patients benefit the most from POCUS and whether the results are applicable in other settings.
Related Concept Videos
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
01:17Ultrasonography
During an ultrasonography procedure, a handheld device called...
01:24Imaging Studies II: Ultrasonography