1: Ultrasonography Evaluation for Appendicitis In Children: Can We Safely Reduce CT Scan Utilization?

Article Outline

• Study Objectives
• Methods
• Results
• Conclusion
• Copyright

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Study Objectives 

Appendicitis is the most common pediatric condition requiring emergency surgery. Although CT scan is the most accurate diagnostic modality for this illness, the risks of radiation exposure are not ideal. This study assessed the impact of a radiology department protocol to increase the use of ultrasonography (US) over CT scan in the initial evaluation of suspected pediatric appendicitis.

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Methods 

Retrospective chart review of pediatric emergency department patients undergoing evaluation of appendicitis. Charts before and after the implementation of the ultrasonography protocol (where US was used as the initial imaging modality whenever possible) were reviewed. Patient demographics, CT and US results were recorded for each group. T-test and test characteristics with 95% confidence intervals (CI) were calculated. The gold standard for appendicitis was pathology report; for negative evaluations, return visits for appendicitis within one week of evaluation were used.

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Results 

Sixty-two patients underwent radiographic evaluation for appendicitis before and fifty-two after the ultrasonography protocol was established. Mean age was 13.7 years before and 12.1 years after. There were 15 cases of appendicitis before (24.2%) and 19 cases after (36.5%; p = 0.016). There was a significant reduction in the use of CT scan (75.8% to 44.2%, p=0.0005) and increase in the use of ultrasonography (33.8% to 78.8%, p<0.05) after the ultrasonography protocol was implemented. For US, the false negative rate was 0.05 (95% CI 0.002-0.26) before and 0.07 (95% CI 0.01-0.24) after. There were no false positive ultrasonographys in either group. Overall length of stay was shorter for patients evaluated by US alone versus CT alone (mean 5 hrs 19 min versus 7 hrs 16 min, p <0.005).

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Conclusion 

Implementing a protocol to increase the use of ultrasonography in assessing pediatric appendicitis reduced the number of CT scans performed without increasing the rate of false negative or false positive evaluations. Thus, the radiation exposure was reduced without compromising diagnostic efficacy.