Kristin N Partain1, Adarsh U Patel1, Curtis Travers2, Heather L Short1, Kiery Braithwaite3, Jonathan Loewen3, Kurt F Heiss1, Mehul V Raval4. 1. Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA. 2. Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA. 3. Division of Pediatric Radiology, Department of Radiology and Imaging Services, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA. 4. Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA. Electronic address: mehulvraval@emory.edu.
Abstract
OBJECTIVE: Our aim was to implement a standardized US report that included secondary signs of appendicitis (SS) to facilitate accurate diagnosis of appendicitis and decrease the use of computed tomography (CT) and admissions for observation. METHODS: A multidisciplinary team implemented a quality improvement (QI) intervention in the form of a standardized US report and provided stakeholders with monthly feedback. Outcomes including report compliance, CT use, and observation admissions were compared pretemplate and posttemplate. RESULTS: We identified 387 patients in the pretemplate period and 483 patients in the posttemplate period. In the posttemplate period, the reporting of SS increased from 5.4% to 79.5% (p<0.001). Despite lower rates of appendix visualization (43.9% to 32.7%, p<0.001) with US, overall CT use (8.5% vs 7.0%, p=0.41) and the negative appendectomy rate remained stable (1.0% vs 1.0%, p=1.0). CT utilization for patients with an equivocal ultrasound and SS present decreased (36.4% vs 8.9%, p=0.002) and admissions for observations decreased (21.5% vs 15.3%, p=0.02). Test characteristics of RLQ US for appendicitis also improved in the posttemplate period. CONCLUSION: A focused QI initiative led to high compliance rates of utilizing the standardized US report and resulted in lower CT use and fewer admissions for observation. Study of a Diagnostic Test Level of Evidence: 1.
OBJECTIVE: Our aim was to implement a standardized US report that included secondary signs of appendicitis (SS) to facilitate accurate diagnosis of appendicitis and decrease the use of computed tomography (CT) and admissions for observation. METHODS: A multidisciplinary team implemented a quality improvement (QI) intervention in the form of a standardized US report and provided stakeholders with monthly feedback. Outcomes including report compliance, CT use, and observation admissions were compared pretemplate and posttemplate. RESULTS: We identified 387 patients in the pretemplate period and 483 patients in the posttemplate period. In the posttemplate period, the reporting of SS increased from 5.4% to 79.5% (p<0.001). Despite lower rates of appendix visualization (43.9% to 32.7%, p<0.001) with US, overall CT use (8.5% vs 7.0%, p=0.41) and the negative appendectomy rate remained stable (1.0% vs 1.0%, p=1.0). CT utilization for patients with an equivocal ultrasound and SS present decreased (36.4% vs 8.9%, p=0.002) and admissions for observations decreased (21.5% vs 15.3%, p=0.02). Test characteristics of RLQ US for appendicitis also improved in the posttemplate period. CONCLUSION: A focused QI initiative led to high compliance rates of utilizing the standardized US report and resulted in lower CT use and fewer admissions for observation. Study of a Diagnostic Test Level of Evidence: 1.
Authors: Brian Cohen; Jordan Bowling; Peter Midulla; Edward Shlasko; Neil Lester; Henrietta Rosenberg; Aaron Lipskar Journal: J Pediatr Surg Date: 2015-03-17 Impact factor: 2.545
Authors: Adam B Goldin; Paritosh Khanna; Mahesh Thapa; Jennifer A McBroom; Michelle M Garrison; Marguerite T Parisi Journal: Pediatr Radiol Date: 2011-03-16
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: Ubaidullah Khan; Murad Kitar; Imed Krichen; Kais Maazoun; Rasha Ali Althobaiti; Mostafa Khalif; Mohammad Adwani Journal: Ann Med Surg (Lond) Date: 2018-12-18