A simple algorithm to improve quality while reducing resource utilization in evaluation of suspected appendicitis in children

• Published in: The American journal of surgery Vol. 217; no. 3; pp. 469 - 472
• Main Authors: Esparaz, Joseph R., McGovern, Greg C., Mowrer, Alyssa R., Nierstedt, Ryan T., Biesboer, Elise A., Elger, Breanna M., Pearl, Richard H., Aprahamian, Charles J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2019; Elsevier Limited
• Subjects: Abdomen; Algorithms; Appendectomy; Appendicitis; Children; Computed tomography; Consultation; Diagnostic systems; Emergency medical care; Hospitals; Leukocytes; Medical imaging; Pain; Patients; Pediatrics; Population; Resource utilization; Surgery; Ultrasonic imaging; Ultrasound; United States > US
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2018.11.009

With similar effectiveness of ultrasonography, our institution replaced CT imaging with ultrasound for diagnosing appendicitis in children. An unexpected consequence was the overutilization of ultrasound. Our objective was to establish measures that could help prevent this overuse. A retrospective chart review of 327 consecutive pediatric patients evaluated for appendicitis between October 2014 and September 2015 at our institution was performed. Data on clinical, radiographic, and histopathologic findings were reviewed. Diagnostic accuracy of US and white blood cell (WBC) values was determined. An algorithm was created. 327 (100%) patients received an ultrasound for suspected appendicitis. WBC of 10,000/μl was determined to be the primary discriminant for management and ultrasound utilization. If a WBC ≥10,000/μL had been utilized as criteria for imaging, 49.5% fewer patients would have received an ultrasound. Clinical exam, WBC count, and surgery consultation prior to ultrasonography can lessen then need for ultrasound utilization in children with suspected appendicitis. •Decrease use of CT scans in pediatrics have led to overutilization of ultrasounds.•The use of WBC ≥10,000 μL may eliminate unnecessary ultrasounds.•WBC <10,000 μL can be followed outpatient with next day clinic visit.