Jason W Nielsen1, Laura Boomer1, Kelli Kurtovic1, Eric Lee2, Kevin Kupzyk3, Ryan Mallory4, Brent Adler2, D Gregory Bates2, Brian Kenney5. 1. Department of Surgery, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA. 2. Department of Radiology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA. 3. University of Nebraska Medical Center, Omaha, NE, USA. 4. The Ohio State University College of Medicine, Columbus, OH, USA. 5. Department of Surgery, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA. Electronic address: brian.kenney@nationwidechildrens.org.
Abstract
PURPOSE: Computed tomography (CT) for the diagnosis of appendicitis is associated with radiation exposure and increased cost. In an effort to reduce the diagnostic use of CT scans, we implemented a standardized ultrasound report template based on validated secondary signs of appendicitis. METHODS: In September 2012, as part of a quality improvement project, we developed and introduced a four category standardized ultrasound report template for limited right lower quadrant abdominal ultrasounds. Outcomes for patients undergoing ultrasound or CT scan for appendicitis between 9/10/2012 and 12/31/2013 (Period 2, n=2033) were compared to the three months prior to implementation (Period 1, n=304). RESULTS: In Period 1, 78 of 304 (25.7%) patients had appendicitis versus 385 of 2033 (18.9%) in Period 2 (p=0.006). Non-diagnostic exams decreased from 48% to 0.1% (p<0.001). Ultrasound sensitivity improved from 66.67% to 92.2% (p<0.001). Specificity did not significantly change (96.9% to 97.69%, p=0.46). CT utilization for appendicitis decreased from 44.3% in Period 1 to 14.5% at the end of Period 2 (p<0.001). CONCLUSIONS: Implementation of a standardized ultrasound report template based on validated secondary signs of appendicitis nearly eliminated non-diagnostic exams, improved diagnostic accuracy, and resulted in a striking decrease in CT utilization.
PURPOSE: Computed tomography (CT) for the diagnosis of appendicitis is associated with radiation exposure and increased cost. In an effort to reduce the diagnostic use of CT scans, we implemented a standardized ultrasound report template based on validated secondary signs of appendicitis. METHODS: In September 2012, as part of a quality improvement project, we developed and introduced a four category standardized ultrasound report template for limited right lower quadrant abdominal ultrasounds. Outcomes for patients undergoing ultrasound or CT scan for appendicitis between 9/10/2012 and 12/31/2013 (Period 2, n=2033) were compared to the three months prior to implementation (Period 1, n=304). RESULTS: In Period 1, 78 of 304 (25.7%) patients had appendicitis versus 385 of 2033 (18.9%) in Period 2 (p=0.006). Non-diagnostic exams decreased from 48% to 0.1% (p<0.001). Ultrasound sensitivity improved from 66.67% to 92.2% (p<0.001). Specificity did not significantly change (96.9% to 97.69%, p=0.46). CT utilization for appendicitis decreased from 44.3% in Period 1 to 14.5% at the end of Period 2 (p<0.001). CONCLUSIONS: Implementation of a standardized ultrasound report template based on validated secondary signs of appendicitis nearly eliminated non-diagnostic exams, improved diagnostic accuracy, and resulted in a striking decrease in CT utilization.
Authors: Larry A Binkovitz; Kyle M L Unsdorfer; Prabin Thapa; Amy B Kolbe; Nathan C Hull; Shannon N Zingula; Kristen B Thomas; James L Homme Journal: Pediatr Radiol Date: 2015-08-18
Authors: Larry A Binkovitz; Kyle M L Unsdorfer; Prabin Thapa; Amy B Kolbe; Nathan C Hull; Shannon N Zingula; Kristen B Thomas; James L Homme Journal: Pediatr Radiol Date: 2015-08-18
Authors: Kristin N Partain; Adarsh Patel; Curtis Travers; Courtney E McCracken; Jonathan Loewen; Kiery Braithwaite; Kurt F Heiss; Mehul V Raval Journal: J Pediatr Surg Date: 2016-03-12 Impact factor: 2.545
Authors: Kristin N Partain; Adarsh U Patel; Curtis Travers; Heather L Short; Kiery Braithwaite; Jonathan Loewen; Kurt F Heiss; Mehul V Raval Journal: J Pediatr Surg Date: 2016-12-05 Impact factor: 2.545