Peña B M, Taylor G A, Fishman S J, Mandl K D
Department of Medicine, Division of Emergency Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA.
Pediatrics. 2000 Oct;106(4):672-6. doi: 10.1542/peds.106.4.672.
A protocol of ultrasonography (US) followed by computed tomography with rectal contrast (CTRC) has been shown to be 94% accurate in the diagnosis of acute appendicitis in children.
To evaluate the changes in patient management and costs of a protocol using US and CTRC in the evaluation of appendicitis in children.
DESIGN, SETTING, AND SUBJECTS: Prospective cohort study of 139 children between 3 and 21 years of age who had equivocal clinical findings for acute appendicitis seen in the emergency department of a large, urban pediatric teaching hospital between July 1998 and December 1998.
Children with equivocal clinical presentations for acute appendicitis were prospectively evaluated with US. Patients with positive findings for acute appendicitis went directly to the operating room. Patients with negative or equivocal findings on US underwent CTRC. Surgical management plans were recorded before imaging, after US, and after CTRC.
Surgical management plans before and after the imaging protocol as well as total hospital direct and indirect costs incurred or saved by each change in management were determined. Costs were obtained through the hospital's cost database and by ratios of costs to charges.
Of the 139 children, the protocol resulted in a beneficial change in management in 86 children (61.9%), no change in management in 50 children (36.0%) and an incorrect change in management in 3 children (2.1%). US alone resulted in a beneficial change in management decision in 12/31 children (38.7%), while US followed by CTRC resulted in a beneficial change in management in 74/108 children (68.5%). The protocol resulted in a total cost savings of $78 503.99 or $565/patient.
A protocol of US followed by CTRC in children with negative or equivocal US examinations results in a high rate of beneficial change in management as well as in total cost savings in children with equivocal clinical presentations for suspected appendicitis.
超声检查（US）联合直肠造影计算机断层扫描（CTRC）方案在诊断儿童急性阑尾炎方面的准确率已达94%。
评估采用US和CTRC方案评估儿童阑尾炎时患者管理及费用的变化。
设计、地点和研究对象：对1998年7月至1998年12月期间在一家大型城市儿科教学医院急诊科就诊的139名3至21岁临床表现不明确的急性阑尾炎患儿进行前瞻性队列研究。
对临床表现不明确的急性阑尾炎患儿进行前瞻性US评估。急性阑尾炎检查结果阳性的患者直接进入手术室。US检查结果为阴性或不明确的患者接受CTRC检查。在成像前、US检查后和CTRC检查后记录手术管理计划。
确定成像方案前后的手术管理计划，以及每次管理变化所产生或节省的医院直接和间接总费用。费用通过医院成本数据库及成本与收费比率获得。
139名儿童中，该方案使86名儿童（61.9%）的管理得到有益改变，50名儿童（36.0%）的管理无变化，3名儿童（2.1%）的管理出现错误改变。仅US检查使12/31名儿童（38.7%）的管理决策得到有益改变，而US检查后再进行CTRC检查使74/108名儿童（68.5%）的管理得到有益改变。该方案共节省成本78503.99美元，即每位患者节省565美元。
对于US检查结果为阴性或不明确的儿童，采用先US后CTRC的方案可使疑似阑尾炎临床表现不明确的儿童管理得到有益改变的比例较高，同时实现总成本节省。
