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A Magnetic Resonance Imaging Protocol for the Evaluation of Pediatric Postappendectomy Abscess: A Quality Improvement
Alicia C Greene1, Marc M Mankarious1, Madeline Matzelle-Zywicki2
1Department of Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania.
Insights
A new magnetic resonance imaging protocol significantly reduced computed tomography (CT) scans for pediatric postappendectomy abscess, lowering radiation exposure in children while maintaining diagnostic accuracy.
Area of Science:
- Pediatric radiology
- Medical imaging techniques
- Quality improvement in healthcare
Background:
- Computed tomography (CT) scans expose children to ionizing radiation for postappendectomy abscess evaluation.
- Reducing CT utilization is crucial for minimizing radiation risks in pediatric patients.
Purpose of the Study:
- To decrease CT scan use by 50% in pediatric postappendectomy patients within 12 months.
- To sustain reduced CT scan utilization for at least one year.
Main Methods:
- Implemented a comprehensive magnetic resonance imaging (MRI) protocol to replace CT scans for suspected postappendectomy abscess.
- Compared diagnostic and clinical outcomes pre- and post-protocol implementation (2015-2022).
- Utilized quality improvement methodology for protocol design and implementation.
Main Results:
- CT scan use decreased from 100% pre-implementation to 24% annually post-implementation.
- Initial adherence challenges were overcome with improved education and reinforcement.
- Diagnostic accuracy and clinical outcomes (abscess detection, diagnosis time, procedures, readmissions) remained comparable.
Conclusions:
- An MRI protocol effectively reduced CT utilization in pediatric postappendectomy abscess cases.
- This approach maintains diagnostic efficacy and clinical outcomes while reducing radiation exposure.
- Quality improvement principles were key to achieving and sustaining the targeted reduction in CT use.
Introduction:
Computed tomography (CT) scans are often used when cross-sectional imaging is required for evaluation of postappendectomy abscess, exposing children to a source of ionizing radiation. Our aim was to decrease the use of CT scans in pediatric postappendectomy patients by 50% in 12 mo and to sustain those results for 1 y.
Methods:
A comprehensive magnetic resonance imaging protocol was introduced in 2018 at a tertiary children's hospital within a general health system to replace CT scans in suspected pediatric postappendectomy abscess. Diagnostic and clinical outcomes were compared preprotocol (2015-2017) and postprotocol (2018-2022) implementation using standard univariate statistics. P < 0.05 was considered significant. Quality improvement methodology was used to design and implement the protocol.
Results:
Sixty eight pediatric postappendectomy patients received cross-sectional imaging during the study period. Overall, CT scans were used exclusively (100%, n = 27) in the preimplementation period compared to 31.7% (n = 13) of cross-sectional imaging in the postimplementation period. However, in the first year of protocol implementation, CT scan use only decreased to 78% of cross-sectional studies performed. The majority of protocol deviations (54%) also occurred in this time period. With improved education and reinforcement, CT scan utilization decreased to approximately 24% of cross-sectional studies annually. Missed abscess rate, time to diagnosis, drainage procedure type, readmission, and reoperation were similar between preimplementation and postimplementation periods.
Conclusions:
Implementation of a postappendectomy abscess magnetic resonance imaging protocol was associated with decreased CT utilization in the pediatric population, while maintaining comparable diagnostic evaluation and clinical outcomes. Adherence to quality improvement principles facilitated achieving goals and sustaining gains.
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