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

45 Scopus citations


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
Issue number1
StatePublished - Jan 1 2015



  • Acute appendicitis
  • Computed tomography
  • Secondary signs
  • Ultrasound

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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