Less Dose, Same Care: Evaluating Computed Tomography Utilization for Pediatric Appendicitis.

Autor: Sutyak KM; Department of Pediatric Surgery, University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice (CSTEP), UTHSC at Houston, Houston, TX., Anderson I; Department of Pediatric Surgery, University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice (CSTEP), UTHSC at Houston, Houston, TX., Young Y; Department of Pediatric Surgery, University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice (CSTEP), UTHSC at Houston, Houston, TX., Jayarajan N; Department of Pediatric Surgery, University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice (CSTEP), UTHSC at Houston, Houston, TX., Garcia EI; Department of Pediatric Surgery, University of Texas Health Science Center at Houston, Houston, TX., Hebballi NB; Department of Pediatric Surgery, University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice (CSTEP), UTHSC at Houston, Houston, TX., Broussard M; Department of Pediatric Surgery, University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice (CSTEP), UTHSC at Houston, Houston, TX., Hedge B; Department of Pediatric Surgery, University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice (CSTEP), UTHSC at Houston, Houston, TX., Ghosh N; Department of Pediatric Surgery, University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice (CSTEP), UTHSC at Houston, Houston, TX., John S; Department of Radiology, University of Texas Health Science Center at Houston, Houston, TX., Rose S; Department of Radiology, University of Texas Health Science Center at Houston, Houston, TX., Lally KP; Department of Pediatric Surgery, University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice (CSTEP), UTHSC at Houston, Houston, TX., Tsao K; Department of Pediatric Surgery, University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice (CSTEP), UTHSC at Houston, Houston, TX. Electronic address: kuojen.tsao@uth.tmc.edu.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2024 Dec; Vol. 176 (6), pp. 1739-1744. Date of Electronic Publication: 2024 Oct 05.
DOI: 10.1016/j.surg.2024.09.002
Abstrakt: Background: An ultrasonography-first, magnetic resonance imaging-second protocol, and attention to dose reduction was implemented to reduce computed tomography rates for appendicitis at our institution. We aimed to compare current computed tomography usage and report radiation doses at our children's associated system hospitals and referring nonsystem hospitals.
Methods: A retrospective study of pediatric patients who underwent appendectomy and had a preoperative computed tomography scan between June 2020 and June 2023 was performed. Demographics and imaging details were abstracted from the medical record. Size-specific dose estimates and effective dose estimates were calculated for each computed tomography. Size-specific dose estimates were compared with American College of Radiology Dose Index Registry diagnostic reference levels.
Results: Of 1,419 patients, 409 (29%) received a computed tomography for appendicitis, a 56% reduction from previous years (2012-2015) (P < .001). Overall, 352 computed tomography scans had dose data available, of which 291 (83%) were performed at system hospitals and 61 (17%) at nonsystem hospitals. The median size-specific dose estimate per computed tomography was 11.0 mGy (interquartile range 7.0, 17.4) for nonsystem hospitals and 9.1 mGy (interquartile range 6.6, 14.0) for system hospitals. The median effective dose per computed tomography was 6.7 mSv (interquartile range 4.3, 12.9) at nonsystem hospitals and 5.1 mSv (interquartile range 3.3, 9.4) at system hospitals. Nienty-three (n = 273) computed tomography scans performed at system hospitals and 30 computed tomography scans (n = 61) at nonsystem hospitals exceeded American College of Radiology Dose Index Registry age-based diagnostic reference levels.
Conclusion: The ultrasonography-first, magnetic resonance imaging-second protocol resulted in a significant decrease in computed tomography use for appendicitis diagnosis. Comparison of doses to American College of Radiology Dose Index Registry reference levels suggests that computed tomography protocol optimization may allow for dose reduction at some facilities.
Competing Interests: Conflict of Interest/Disclosure The authors have no conflicts of interest to declare.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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