Ming Chien1, Arie Habis2, Loretto Glynn3, Ann O'Connor3, Tracie L Smith4, Francis Prendergast5. 1. Division of Emergency Medicine, Department of Pediatrics, Central DuPage Hospital, Winfield, IL, USA. mingtchien@yahoo.com. 2. Division of Emergency Medicine, Department of Pediatrics, Central DuPage Hospital, Winfield, IL, USA. 3. Division of Pediatric Surgery, Department of Pediatrics, Central DuPage Hospital, Winfield, IL, USA. 4. Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. 5. Division of Pediatric Radiology, Department of Pediatrics, Central DuPage Hospital, Winfield, IL, USA.
Abstract
PURPOSE: Despite significant radiation exposure involved with computed tomography (CT) in evaluation of pediatric appendicitis, its use is still widespread. The goal of this study was to assess the effect of a staged imaging pathway for appendicitis to significantly decrease CT use while maintaining diagnostic accuracy. METHODS: Chart review was performed for patients evaluated for appendicitis over a 12-month period prior to and after pathway implementation. RESULTS: There was a significant decrease in CT use as initial imaging after implementation of the pathway; 87.1-13.4 % for evaluations positive for appendicitis (decrease 84.6 %, p < 0.0001) and 82.6-9.2 % for evaluations negative for appendicitis (decrease 88.9 %, p < 0.0001). Use of CT during any point in the evaluation decreased from 91.7 to 25.1 % (decrease 72.6 %, p < 0.0001). The negative appendectomy rate was similar; 5.4 % prior, 4.9 % post (p = 0.955). The missed appendicitis rate did not statistically change; 1.1 % prior, 3.7 % post (p = 0.523). The perforation rate was not statistically altered; 6.5 % prior; 9.8 % post (p = 0.421). 350 less patients underwent CT during the year following the pathway. CONCLUSIONS: The staged imaging pathway resulted in a marked decrease in children exposed to CT without compromising diagnostic accuracy.
PURPOSE: Despite significant radiation exposure involved with computed tomography (CT) in evaluation of pediatric appendicitis, its use is still widespread. The goal of this study was to assess the effect of a staged imaging pathway for appendicitis to significantly decrease CT use while maintaining diagnostic accuracy. METHODS: Chart review was performed for patients evaluated for appendicitis over a 12-month period prior to and after pathway implementation. RESULTS: There was a significant decrease in CT use as initial imaging after implementation of the pathway; 87.1-13.4 % for evaluations positive for appendicitis (decrease 84.6 %, p < 0.0001) and 82.6-9.2 % for evaluations negative for appendicitis (decrease 88.9 %, p < 0.0001). Use of CT during any point in the evaluation decreased from 91.7 to 25.1 % (decrease 72.6 %, p < 0.0001). The negative appendectomy rate was similar; 5.4 % prior, 4.9 % post (p = 0.955). The missed appendicitis rate did not statistically change; 1.1 % prior, 3.7 % post (p = 0.523). The perforation rate was not statistically altered; 6.5 % prior; 9.8 % post (p = 0.421). 350 less patients underwent CT during the year following the pathway. CONCLUSIONS: The staged imaging pathway resulted in a marked decrease in children exposed to CT without compromising diagnostic accuracy.
Authors: J E Jacobs; B A Birnbaum; M Macari; A J Megibow; G Israel; D D Maki; A M Aguiar; C P Langlotz Journal: Radiology Date: 2001-09 Impact factor: 11.105
Authors: Naresh Ramarajan; Rajesh Krishnamoorthi; Richard Barth; Pejman Ghanouni; Claudia Mueller; Bernard Dannenburg; N Ewen Wang Journal: Acad Emerg Med Date: 2009-11 Impact factor: 3.451
Authors: W Scott Russell; Abigail M Schuh; Jeanne G Hill; Andre Hebra; Robert A Cina; Charles D Smith; Christian J Streck Journal: Pediatr Emerg Care Date: 2013-05 Impact factor: 1.454