Reducing computed tomography scans for appendicitis by introduction of a standardized and validated ultrasonography report template

Jason W. Nielsen, Laura Boomer, Kelli Kurtovic, Eric Lee, Kevin Kupzyk, Ryan Mallory, Brent Adler, D. Gregory Bates, Brian Kenney

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Purpose: Computed tomography (CT) for the diagnosis of appendicitis is associated with radiation exposure and increased cost. In an effort to reduce the diagnostic use of CT scans, we implemented a standardized ultrasound report template based on validated secondary signs of appendicitis. Methods: In September 2012, as part of a quality improvement project, we developed and introduced a four category standardized ultrasound report template for limited right lower quadrant abdominal ultrasounds. Outcomes for patients undergoing ultrasound or CT scan for appendicitis between 9/10/2012 and 12/31/2013 (Period 2, n =2033) were compared to the three months prior to implementation (Period 1, n= 304). Results: In Period 1, 78 of 304 (25.7%) patients had appendicitis versus 385 of 2033 (18.9%) in Period 2 (p=0.006). Non-diagnostic exams decreased from 48% to 0.1% (p < 0.001). Ultrasound sensitivity improved from 66.67% to 92.2% (p < 0.001). Specificity did not significantly change (96.9% to 97.69%, p=0.46). CT utilization for appendicitis decreased from 44.3% in Period 1 to 14.5% at the end of Period 2 (p < 0.001). Conclusions: Implementation of a standardized ultrasound report template based on validated secondary signs of appendicitis nearly eliminated non-diagnostic exams, improved diagnostic accuracy, and resulted in a striking decrease in CT utilization.

Original languageEnglish (US)
Pages (from-to)144-148
Number of pages5
JournalJournal of pediatric surgery
Volume50
Issue number1
DOIs
StatePublished - Jan 1 2015

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Appendicitis
Ultrasonography
Tomography
Quality Improvement
Costs and Cost Analysis

Keywords

  • Acute appendicitis
  • Computed tomography
  • Secondary signs
  • Ultrasound

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Reducing computed tomography scans for appendicitis by introduction of a standardized and validated ultrasonography report template. / Nielsen, Jason W.; Boomer, Laura; Kurtovic, Kelli; Lee, Eric; Kupzyk, Kevin; Mallory, Ryan; Adler, Brent; Bates, D. Gregory; Kenney, Brian.

In: Journal of pediatric surgery, Vol. 50, No. 1, 01.01.2015, p. 144-148.

Research output: Contribution to journalArticle

Nielsen, Jason W. ; Boomer, Laura ; Kurtovic, Kelli ; Lee, Eric ; Kupzyk, Kevin ; Mallory, Ryan ; Adler, Brent ; Bates, D. Gregory ; Kenney, Brian. / Reducing computed tomography scans for appendicitis by introduction of a standardized and validated ultrasonography report template. In: Journal of pediatric surgery. 2015 ; Vol. 50, No. 1. pp. 144-148.
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