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Effect of an Evaluation Algorithm on CT Utilization in Identifying Appendicitis in Children.
Kendra L Sikes1, Rebecca J Hart2, Yana Feygin1
1From the Interdisciplinary Research Group.
Pediatric Emergency Care
|February 17, 2024
Summary
An appendicitis evaluation algorithm did not significantly change computed tomography (CT) use or length of stay (LOS) in pediatric patients. However, the algorithm was associated with a significant increase in emergency department (ED) length of stay.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Clinical Algorithm Implementation
Background:
- Acute appendicitis is a common surgical emergency in children.
- Computed tomography (CT) and ultrasound are frequently used for diagnosis, impacting patient care and resource utilization.
- Standardized evaluation algorithms aim to optimize diagnostic pathways.
Purpose of the Study:
- To evaluate the impact of an appendicitis evaluation algorithm on CT utilization and length of stay (LOS) in pediatric patients.
- To determine if the algorithm led to significant changes in diagnostic imaging rates and patient disposition times.
Main Methods:
- Retrospective chart review of pediatric patients (3-18 years) evaluated for appendicitis.
- Data collected for 6 months pre- and post-algorithm implementation, with a 3-month washout period.
- Analysis of CT and ultrasound utilization rates, and emergency department (ED) LOS using statistical tests (chi-squared, Mann-Whitney U).
Main Results:
- No significant change in CT utilization (25.7% to 24.8%) or ultrasound utilization (59.5% to 59.7%).
- A significant increase in total ED median LOS was observed (333.50 to 362.00 minutes; P = 0.011).
- Factors associated with CT use included fever, pain migration, and right lower quadrant tenderness.
Conclusions:
- The implemented appendicitis evaluation algorithm did not significantly reduce CT utilization or LOS.
- High rates of equivocal ultrasound findings may contribute to continued CT use and increased LOS.
- Further refinement of diagnostic strategies is needed to optimize care for pediatric appendicitis evaluations.
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