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Reduced Computed Tomography for Appendicitis in Children after Implementation of Next-day Surgery Clinic Follow-up

The use of computed tomography (CT) in the emergency department (ED) evaluation of pediatric patients for suspected appendicitis can be safely reduced. However, published examples of reduced CT use also report increased MRI utilization, ED length of stay, hospitalization rates, and in-ED surgical co...

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Autores principales: Ryan, Sydney, Dudley, Nanette C., Schunk, Jeff E., Weng, Cindy, Skarda, David E., Glissmeyer, Eric W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10013624/
https://www.ncbi.nlm.nih.gov/pubmed/36926215
http://dx.doi.org/10.1097/pq9.0000000000000641
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author Ryan, Sydney
Dudley, Nanette C.
Schunk, Jeff E.
Weng, Cindy
Skarda, David E.
Glissmeyer, Eric W.
author_facet Ryan, Sydney
Dudley, Nanette C.
Schunk, Jeff E.
Weng, Cindy
Skarda, David E.
Glissmeyer, Eric W.
author_sort Ryan, Sydney
collection PubMed
description The use of computed tomography (CT) in the emergency department (ED) evaluation of pediatric patients for suspected appendicitis can be safely reduced. However, published examples of reduced CT use also report increased MRI utilization, ED length of stay, hospitalization rates, and in-ED surgical consultation. In addition, previous studies recommended follow-up for undifferentiated abdominal pain, yet none with pediatric surgeons. Therefore, we implemented a diagnostic algorithm that includes an option for next-day surgery clinic follow-up in cases where uncertainty remains after appendix ultrasound (US) to reduce CT utilization without increasing hospital-based resources. METHODS: We implemented a diagnostic algorithm in January 2014. We retrospectively identified 4,577 patients who underwent an evaluation for suspected appendicitis from January 2012 to September 2015. CT utilization was compared before and after implementation using Statistical Process Control. In addition, we evaluated secondary outcomes, including US utilization, hospital admission, surgery clinic follow-up, ED surgery consultation, ED return visits within 7 days, and ED length of stay. RESULTS: Following the implementation of the algorithm, CT utilization decreased significantly from 13.8% to 6%. Forty-eight patients were evaluated the next day in the optional pediatric surgery clinic for 21 months after implementation. There was no significant change in US utilization, hospital admission, ED surgery consultation, ED return visits within 7 days, or ED length of stay. CONCLUSION: We achieved decreased CT utilization without an increase in the utilization of other hospital-based resources after implementing a pediatric appendicitis evaluation algorithm that includes the option for next-day pediatric surgery clinic follow-up.
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spelling pubmed-100136242023-03-15 Reduced Computed Tomography for Appendicitis in Children after Implementation of Next-day Surgery Clinic Follow-up Ryan, Sydney Dudley, Nanette C. Schunk, Jeff E. Weng, Cindy Skarda, David E. Glissmeyer, Eric W. Pediatr Qual Saf Individual QI projects from single institutions The use of computed tomography (CT) in the emergency department (ED) evaluation of pediatric patients for suspected appendicitis can be safely reduced. However, published examples of reduced CT use also report increased MRI utilization, ED length of stay, hospitalization rates, and in-ED surgical consultation. In addition, previous studies recommended follow-up for undifferentiated abdominal pain, yet none with pediatric surgeons. Therefore, we implemented a diagnostic algorithm that includes an option for next-day surgery clinic follow-up in cases where uncertainty remains after appendix ultrasound (US) to reduce CT utilization without increasing hospital-based resources. METHODS: We implemented a diagnostic algorithm in January 2014. We retrospectively identified 4,577 patients who underwent an evaluation for suspected appendicitis from January 2012 to September 2015. CT utilization was compared before and after implementation using Statistical Process Control. In addition, we evaluated secondary outcomes, including US utilization, hospital admission, surgery clinic follow-up, ED surgery consultation, ED return visits within 7 days, and ED length of stay. RESULTS: Following the implementation of the algorithm, CT utilization decreased significantly from 13.8% to 6%. Forty-eight patients were evaluated the next day in the optional pediatric surgery clinic for 21 months after implementation. There was no significant change in US utilization, hospital admission, ED surgery consultation, ED return visits within 7 days, or ED length of stay. CONCLUSION: We achieved decreased CT utilization without an increase in the utilization of other hospital-based resources after implementing a pediatric appendicitis evaluation algorithm that includes the option for next-day pediatric surgery clinic follow-up. Lippincott Williams & Wilkins 2023-03-13 /pmc/articles/PMC10013624/ /pubmed/36926215 http://dx.doi.org/10.1097/pq9.0000000000000641 Text en Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Individual QI projects from single institutions
Ryan, Sydney
Dudley, Nanette C.
Schunk, Jeff E.
Weng, Cindy
Skarda, David E.
Glissmeyer, Eric W.
Reduced Computed Tomography for Appendicitis in Children after Implementation of Next-day Surgery Clinic Follow-up
title Reduced Computed Tomography for Appendicitis in Children after Implementation of Next-day Surgery Clinic Follow-up
title_full Reduced Computed Tomography for Appendicitis in Children after Implementation of Next-day Surgery Clinic Follow-up
title_fullStr Reduced Computed Tomography for Appendicitis in Children after Implementation of Next-day Surgery Clinic Follow-up
title_full_unstemmed Reduced Computed Tomography for Appendicitis in Children after Implementation of Next-day Surgery Clinic Follow-up
title_short Reduced Computed Tomography for Appendicitis in Children after Implementation of Next-day Surgery Clinic Follow-up
title_sort reduced computed tomography for appendicitis in children after implementation of next-day surgery clinic follow-up
topic Individual QI projects from single institutions
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10013624/
https://www.ncbi.nlm.nih.gov/pubmed/36926215
http://dx.doi.org/10.1097/pq9.0000000000000641
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