Reducing Postoperative CT Imaging for Children With Complicated Appendicitis: A Pediatric Surgical Quality...

Area of Science:

• Pediatric Surgery
• Radiology
• Quality Improvement

Background:

• Computed tomography (CT) scanning postoperatively for appendicitis remains common despite efforts to reduce ionizing radiation.
• The Pediatric Surgery Quality Collaborative (PSQC) investigated variations in CT usage among children's hospitals.

Purpose of the Study:

• To identify differences in postoperative CT utilization for complicated appendicitis between high and low-usage children's hospitals.
• To explore factors influencing the decision-making process for postoperative imaging in pediatric appendicitis cases.

Main Methods:

• Analysis of National Surgery Quality Improvement Program Pediatric data from PSQC hospitals (April 2020-March 2021).
• Semi-structured interviews with key stakeholders from 11 hospitals (5 low CT, 6 high CT).
• Qualitative analysis of interview transcripts using the Theoretical Domains Framework (TDF).

Main Results:

• Five TDF domains significantly influenced CT use: skills, beliefs about capabilities, intentions/goals, memory/decision processes, and environment.
• Low-CT hospitals demonstrated trust in ultrasound technicians, prioritized delayed imaging (≥7 days), possessed quality improvement resources, fostered interdisciplinary trust, and emphasized radiation stewardship.

Conclusions:

• Hospitals with extreme variations in postoperative CT use offer insights into effective strategies.
• Key improvement strategies include developing and adhering to imaging protocols, ensuring quality improvement resources, promoting interdisciplinary collaboration, and championing radiation stewardship.