Resource utilization and outcomes among children risk stratified by pediatric appendicitis risk calculator at a
Callie R Becker1, Kelly R Bergmann2, Gabriela Vazquez-Benitez3
1Division of Pediatric Emergency Medicine, Department of Pediatrics, M Health Fairview Masonic Children's Hospital, Minneapolis, Minnesota, USA.
Insights
The pediatric appendicitis risk calculator (pARC) shows high resource use in low-risk children. Stratifying care by pARC score may reduce costs and improve outcomes for pediatric appendicitis diagnosis.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Health Economics
Background:
- Appendicitis is a frequent surgical condition in children.
- The pediatric appendicitis risk calculator (pARC) aids clinical decision-making.
- Evaluating resource use in pediatric appendicitis is crucial for cost-effective care.
Purpose of the Study:
- To assess resource utilization and clinical outcomes in children undergoing appendix ultrasound (US) stratified by pARC score.
- To compare costs for low-risk pARC patients versus those without advanced imaging.
Main Methods:
- Prospective observational cohort study of 407 children (aged 5-18) with suspected appendicitis.
- Risk stratification using the pARC score.
- Analysis of appendicitis rates, US findings, CT scans, hospitalizations, and total charges.
Main Results:
- Appendicitis rate was 3.3% for pARC <15% and 96.8% for pARC ≥85%.
- For pARC <15%, negative appendectomy rate was 28.6%, with 19% CT scans and 23% hospitalizations.
- Median charges for pARC <15% were $3756, versus $2484 for ED patients without advanced imaging, a $1272 savings per patient.
Conclusions:
- Significant resource utilization occurs in pediatric appendicitis cases with low pARC scores.
- pARC score-based care stratification offers potential to reduce resource use in pediatric patients.
Objectives:
Appendicitis is a common pediatric condition requiring surgery. The pediatric appendicitis risk calculator (pARC) was recently developed to guide clinical care. The objective of this study is to describe resource utilization and clinical outcomes among children with appendix ultrasound (US) scans risk stratified by pARC score.
Methods:
Prospective enrolled observational cohort single-center study of children aged 5-18, who had an US for suspected appendicitis. We estimated the rate of appendicitis, rate of equivocal US scans, and resource utilization by pARC score strata. Total adjusted charges were determined for low-risk pARC patients compared to discharged emergency department (ED) patients with abdominal pain and complete blood count (CBC) obtained without advanced abdominal imaging.
Results:
Over the 13-month study period, 407 children were enrolled. The overall rate of appendicitis was 33.4%, and 199 (49%) were male. The observed rate of appendicitis was 3.3% in those with a pARC score of <15% and 96.8% in those with a pARC score of ≥85%. Of enrolled patients, 152 (37.3%) had a pARC score <15%. Of those with a pARC score of <15%, the negative appendectomy rate was 28.6%, and the rate of equivocal US was 49.3%. The rate of CT scans and hospitalizations was 19% and 23%, respectively. Median total charges for patients with pARC <15% with usual care were $3756. Median total charges for patients presenting to the ED with abdominal pain who had a CBC but no advanced abdominal imaging performed was $2484, indicating a potential savings of $1272 per patient.
Conclusions:
There is a high rate of resource utilization among patients who are low appendicitis risk by pARC score. Outcome variation by pARC scores presents future opportunity to selectively reduce resource utilization in pediatric patients.
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