Katherine Bakes, MD

Use of ultrasound and early surgical consultation decreased CT imaging from 39% to 18%.

Investigators compared utilization of computed tomography (CT) before and after implementation of a new institutional algorithm for evaluating patients aged 18 and younger with suspected acute appendicitis. Only patients who underwent operative intervention were included in the analysis.

The algorithm involved early pediatric surgery consultation (prior to CT) for patients with the following: (1) unequivocal history and physical exam for appendicitis, (2) equivocal history, physical exam, and ultrasound results, or (3) suspected perforated appendicitis. Patients with appendicitis detected by ultrasound received surgical intervention without CT imaging, while patients with equivocal physical exams and negative ultrasound results were considered not to have appendicitis.

Of 331 patients (mean age, 11 years), 135 presented during the 2 years before implementation of the algorithm and 196 presented during the 3 years after. CT use significantly decreased from 39% pre-algorithm to 18% post-algorithm. Negative appendectomy rates did not differ between periods (9% and 11%).

Citation(s):

Polites SF et al. A simple algorithm reduces computed tomography use in the diagnosis of appendicitis in children. Surgery 2014 Aug 15; 156:448.