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Reducing Computed Tomography Use for Appendicitis Evaluation in a Pediatric Emergency Department: A Multidisciplinary
Jennifer Hockenbury1, Monica E Lopez2, Caroline M Godfrey2
1From the Division of Pediatric Emergency Medicine, University of Louisville, Louisville, Ky.
Pediatric Quality & Safety
|May 20, 2025
Summary
A quality improvement initiative successfully reduced computed tomography (CT) use for pediatric appendicitis evaluation from 31.3% to 12.1%. This sustained reduction in CT scans did not negatively affect patient outcomes.
Area of Science:
- Pediatric Surgery
- Radiology
- Quality Improvement Science
Background:
- Appendicitis is a common pediatric surgical emergency.
- Computed tomography (CT) is frequently overused in diagnosing pediatric appendicitis.
- Institutional CT utilization rates exceeded those of peer hospitals.
Purpose of the Study:
- To decrease CT utilization for pediatric appendicitis evaluation from 31.3% to 15% within 12 months.
- Implement a multidisciplinary quality improvement initiative.
Main Methods:
- A quality improvement initiative was conducted in a pediatric emergency department (PED) from September 2021 to October 2022.
- Interventions included a clinical practice guideline, electronic medical record order set for decision support, and standardized ultrasound reporting.
- Data were analyzed using statistical process control charts.
Main Results:
- A total of 2,010 patients were evaluated for appendicitis.
- CT utilization decreased from a baseline of 31.3% to 12.1% and was sustained for 10 months.
- No significant impact was observed on negative pathology appendectomy rates or 72-hour return visits.
Conclusions:
- Quality improvement methodologies can effectively reduce CT utilization in pediatric appendicitis diagnosis.
- Sustained reduction in CT scans is achievable without compromising patient safety or diagnostic accuracy.
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