Improving the diagnostic accuracy of appendicitis using a multidisciplinary pathway
| Autor: | Vikram Sabhaney, Erik D. Skarsgard, Heather Bray, Saroop Dhatt |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Abdominal ultrasound Diagnostic accuracy Appendix Sensitivity and Specificity 03 medical and health sciences 0302 clinical medicine Risk groups Risk Factors 030225 pediatrics Internal medicine medicine Confidence Intervals Appendectomy Humans Child Diagnostic Techniques and Procedures Ultrasonography Clinical Audit business.industry Outcome measures Level iv General Medicine medicine.disease Appendicitis Alvarado score 030220 oncology & carcinogenesis Child Preschool Pediatrics Perinatology and Child Health Surgery Female Suspected appendicitis business Emergency Service Hospital |
| Zdroj: | Journal of pediatric surgery. 55(5) |
| ISSN: | 1531-5037 |
| Popis: | Background/Purpose Improvement opportunities exist in the accuracy and timeliness of the diagnosis of childhood appendicitis. The purpose of our study was to conduct a post-implementation audit of a diagnostic pathway for children with suspected appendicitis presenting to our pediatric emergency department. Methods We adopted a diagnostic pathway that utilized a validated risk of appendicitis stratification tool (Alvarado Score) with protocolized use of abdominal ultrasound for moderate risk patients. We conducted a 10% convenience sample audit of pathway patients treated over the subsequent 18-month period. Outcome measures included false negative and positive rates, sensitivity, specificity, and overall pathway accuracy. Results One hundred thirty-four pathway patients, of which 22 (16.4%) had appendicitis confirmed pathologically, were evaluated. The risk group distribution of patients was: low risk (29%), moderate risk (60%), and high risk (11%). The negative appendectomy rate was 4.4% (reduced from 14% pre-pathway), and the false negative (missed appendicitis) rate was 3.0%. No patients received CT scans. Pathway sensitivity was 81.8%% (95% CI 59.7% to 94.8%), specificity-92.9%% (95% CI 86.4%–96.9%), and overall accuracy-91.0% (95% CI 84.9%–95.3%). Conclusion Implementation of a diagnostic pathway achieved a high level of accuracy and reduced our institutional negative appendectomy rate by 67%. The audit identified additional pathway improvement opportunities. Levels of Evidence Level IV. |
| Databáze: | OpenAIRE |
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