A Standardized Diagnostic Pathway for Suspected Appendicitis in Children Reduces Unnecessary Imaging.

Autor:	D'Cruz RJ; Department of Pediatric General Surgery, Nemours Children's Health, Wilmington, Del., Linden AF; Department of Pediatric General Surgery, Nemours Children's Health, Wilmington, Del.; Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pa., Devin CL; Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pa., Savage J; Department of Emergency Medicine, Nemours Children's Health, Wilmington, Del., Zomorrodi A; Department of Emergency Medicine, Nemours Children's Health, Wilmington, Del., Reichard KW; Department of Pediatric General Surgery, Nemours Children's Health, Wilmington, Del.; Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pa., Choudhary A; Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Ark., Berman L; Department of Pediatric General Surgery, Nemours Children's Health, Wilmington, Del.; Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pa.
Jazyk:	angličtina
Zdroj:	Pediatric quality & safety [Pediatr Qual Saf] 2022 Mar 30; Vol. 7 (2), pp. e541. Date of Electronic Publication: 2022 Mar 30 (Print Publication: 2022).
DOI:	10.1097/pq9.0000000000000541
Abstrakt:	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. (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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