CT Scan Utilization Decreases With Implementation of a Clinical Pathway for Children With Suspected Acute...

Area of Science:

• Pediatric Surgery
• Diagnostic Imaging
• Healthcare Quality Improvement

Background:

• The National Surgical Quality Improvement Program-Pediatric (NSQIP-P) guidelines recommend limiting computed tomography (CT) scans to under 25% for suspected pediatric appendicitis.
• Overutilization of CT scans in children raises concerns regarding radiation exposure and healthcare costs.

Purpose of the Study:

• To implement and evaluate a multidisciplinary pediatric appendicitis clinical pathway aimed at reducing CT scan utilization.
• To assess the impact of the pathway on diagnostic imaging choices and emergency department length of stay (LOS).

Main Methods:

• A local cohort study reviewed appendicitis cases in patients under 19 years old from 2021 to 2023.
• A clinical pathway was implemented using Plan-Do-Study-Act cycles, emphasizing ultrasound as the primary imaging modality.
• Statistical Process Control charts and Six Sigma rules were used to analyze variations and pathway effectiveness.

Main Results:

• Ultrasound was utilized as first-line imaging in over 90% of cases.
• CT scan utilization decreased from 39% to 22% over the study period.
• Emergency department LOS decreased from an average of 538 to 435 minutes; non-diagnostic ultrasounds decreased from 35% to 20%.

Conclusions:

• Implementation of a pediatric appendicitis clinical pathway successfully reduced CT scan utilization.
• The pathway optimized diagnostic imaging strategies and improved patient flow within the emergency department.