Algorithm Cuts Pediatric CT Use in Suspected Appendicitis

By David Douglas

July 10, 2014

NEW YORK (Reuters Health) - A simple algorithm including components such as physical exam and ultrasound can help diagnose appendicitis in children and reduce the need for computed tomography (CT), researchers say.

The algorithm, "built upon early involvement of the pediatric surgeon . . . decreases the use of imaging, including CT, without compromising diagnostic accuracy," they wrote in a report online June 19th in Surgery.

Dr. Abdalla E. Zarroug and colleagues at the Mayo Clinic in Rochester, Minnesota say use of CT in equivocal cases has increased, because its accuracy is reportedly above 94% - but "multiple studies" have suggested "that blood, brain, and solid organ cancers will develop owing to radiation exposure associated with CT."

To reduce use of CT in the emergency room in such cases, the team developed the algorithm. Among its elements are pediatric surgery consultation without any imaging in patients with unequivocal history, and physical exam and consultation prior to CT for patients with equivocal history, physical exam, and ultrasound results.

To evaluate the utility of the approach, the team examined five years' worth of data on 331 pediatric patients who had appendectomy after presenting to the emergency department.

In the two years before algorithm implementation, 135 patients (40.8%) underwent appendectomy; the other 196 (59.2%) were seen in the three years after implementation.

The use of CT fell significantly from 38% before algorithm implementation to 19% thereafter. The negative appendectomy rate increased slightly but not significantly from 9% to 11% after implementation. Negative appendectomy was not associated with use of imaging, including CT.

"The real implication of our study," Dr. Zarroug told Reuters Health by email, "is that simple algorithms or clinical pathways for common diagnoses such as appendicitis can have a major impact on reducing tests, reducing risks and reducing costs to patients."


Surgery 2014.


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