Background
A diagnostic algorithm for appendicitis in children was created to reduce computed
tomography (CT) use owing to the risk of cancer from radiation exposure and cost of
CT. This study evaluates the impact of the algorithm on CT use and diagnostic accuracy
of appendicitis.
Methods
Patients ≤18 years who underwent appendectomy for suspected appendicitis after presenting
to the emergency department for 2 years before and 3 years after algorithm implementation
were identified. Clinical characteristics and outcomes, including use of CT and negative
appendectomy rate, were compared between the pre- and post-implementation periods.
Multivariable analysis was used to determine the impact of CT on negative appendectomy.
Results
We identified 331 patients—41% in the pre- and 59% in the post-implementation period.
CT utilization decreased from 39% to 18% (P < .001) after implementation. The negative appendectomy rate increased from 9% to
11% (P = .59). Use of CT did not impact the risk of negative appendectomy (P = .64).
Conclusion
Utilization of CT was significantly reduced after implementation of a diagnostic algorithm
for appendicitis without impacting diagnostic accuracy. Given the concern for increased
risk of cancer after CT, these results support use of an algorithm in children with
suspected appendicitis.
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Article info
Publication history
Published online: June 19, 2014
Accepted:
April 2,
2014
Identification
Copyright
© 2014 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
