Purpose or Case Report: General Emergency Departments (ED) continue to have a high usage of CT for the diagnosis of appendicitis in children. Purpose of this project was to see if an interdisciplinary approach in a small community ED could increase the usage of US for the evaluation of appendicitis in children.
Methods & Materials: A community hospital only using CT to assess for pediatric appendicitis brought pediatrics,ED, radiology, surgery together to work on ways to increase US usage. The initial intervention included webinar sessions by a pediatric radiologist situated 3 hours away to teach technique and guide protocol planning and interpretations. A protocol to first order US, with CT to follow as needed was implemented. A second intervention provided 24 hour/ 7 day US coverage. Chart review of children 2-17 years of age evaluated for appendicitis prior and after each intervention was performed . Data - date, age, weight, US result, CT result, path report, disposition and return to ED within 7 days with appendicitis.
Results: 470 children met study criteria, 72 preintervention and 398 postintervention (1st intervention following training/ protocol initiation, 2nd intervention following 24/7 US availability) . CT utilization decreased from 97% to 55% (P<0.001). US increased 7% to 73% (P<0.001). Offering 24/7 US had the greatest affect: group 1, n=72 (preintervention), group 2, n=61 (post 1st intervention before 24/7 US availability) and group 3, n=337 (post 2nd intervention after 24/7 US availability). US increased from 7%-group 1, to 38%-group 2, to 79%-group 3. The proportions b/w group 1 & 2, b/w group 1 & 3 and b/w group 2 & 3 were statistically different (p<0.001). CT decreased from 97% group 1; to 85% group 2; to 50% group 3. Proportions b/w group 1 & 2 were not stat diff (p value 0.15) but proportions b/w group 1 & 3 and groups 2 & 3 were stat diff (p<0.001). Negative appendectomy rate before interventions 0% ; after interventions 3% - missed appendicitis before interventions 0%; after interventions 0.3% not statistically significant.
Conclusions: Utilization of US for pediatric assessment of appendicitis in a community hospital was significantly increased following interventions including webinar training by a pediatric radiologist, interdisciplinary buy in to implement a 2-tier imaging approach and most critically 24/7 US availability. This led to a significant decrease in ED use of CT scans in children.