A Standardized Diagnostic Pathway for Suspected Appendicitis in Children Reduces Unnecessary Imaging
Document Type
Article
Publication Date
3-30-2022
Abstract
Introduction:
Ultrasound (US) for the diagnosis of acute appendicitis is often nondiagnostic, and additional imaging is required. A standardized approach may reduce unnecessary imaging.
Methods:
We retrospectively analyzed all patients who had imaging for appendicitis in our emergency department in 2017 and evaluated patient characteristics associated with nondiagnostic US. Using these results, we developed a pediatric appendicitis score (PAS)-based imaging pathway and compared imaging trends prepathway and postpathway implementation.
Results:
A total of 971 patients received imaging for suspected appendicitis prepathway in 2017. Female sex, obesity, and low/intermediate PAS were significantly associated with nondiagnostic US, but not magnetic resonance imaging (MRI) (P < 0.0001). Nearly one-third of patients received multiple imaging studies (US followed by MRI/computed tomography). As low/intermediate PAS was most strongly associated with a nondiagnostic US on multivariate analysis, we developed a PAS-based imaging stewardship pathway to eliminate imaging in low-PAS patients and reduce the number of patients with an intermediate PAS who received multiple imaging studies by obtaining an MRI as the first-line study. After implementation, only 22 low-PAS patients received imaging (compared with 238 preimplementation), and the proportion of intermediate-PAS patients receiving multiple imaging studies decreased from 31.4% to 13% (P < 0.0001). The cost of imaging per 100 patients increased from $24,255 to $31,082.
Conclusion:
A PAS-based imaging stewardship pathway reduces unnecessary imaging for suspected appendicitis.
Recommended Citation
D'Cruz, Roshan J.; Linden, Allison F.; Devon, Courtney L.; Savage, Jillian; Zomorrodi, Arezoo; Reichard, Kirk W.; Choudhary, Arabinda; and Berman, Loren, "A Standardized Diagnostic Pathway for Suspected Appendicitis in Children Reduces Unnecessary Imaging" (2022). Department of Surgery Faculty Papers. Paper 239.
https://jdc.jefferson.edu/surgeryfp/239
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
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Language
English
Comments
This article is the author's final published version in Pediatric Quality and Safety, Volume 7, Issue 2, March/April 2022, Article number e541.
The published version is available at https://doi.org/10.1097/pq9.0000000000000541. Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.