Wagenaar Amy E, Tashiro Jun, Wang Bo, Curbelo Miosotys, Mendelson Kenneth L, Perez Eduardo A, Hogan Anthony R, Neville Holly L, Sola Juan E
Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.
Department of Pediatrics, Baptist Children's Hospital, Miami, Florida.
J Surg Res. 2015 Nov;199(1):153-8. doi: 10.1016/j.jss.2015.04.028. Epub 2015 Apr 15.
Despite radiation concerns, computed tomography (CT) remains the favored imaging modality at many children's hospitals for appendicitis. We sought to reduce CT utilization for appendicitis in a children's hospital with an algorithm relying on 24-h ultrasound (US) as the primary imaging study.
An US-based protocol for suspected appendicitis was adopted at the end of the fiscal year (FY) 2011. Data were collected for 12 mo before and 24 mo after implementation. Imaging test usage and charges were adjusted per annual number of appendectomies. Training of emergency department staff continued over 1 y after protocol implementation.
For FY 2011, 644 abdominal CT and 1088 appendix US were ordered, and 249 laparoscopic appendectomies (LAs) were performed. After protocol implementation, FY 2012: 535 CT, 1285 US, and 265 LA were performed; and FY 2013: 330 CT, 1235 US, and 236 LA were performed. Length of stay decreased from before to after protocol (2.57 ± 0.29 versus 2.15 ± 0.11 d), P < 0.001. CTs per appendectomy decreased 42% from FY 2011 to FY 2013 (2.43 versus 1.40, P < 0.001) and 30% from before to after protocol (2.43 versus 1.70, P < 0.001). A corresponding 27% increase in number of US before to after protocol (4.11 versus 5.20 US/appendectomy, P = 0.004) occurred. CT and US charges decreased $2253 and $6633 per appendectomy for FY 2012 and 2013, respectively.
Protocol-driven workup with US significantly reduced CT utilization, radiation exposure, and imaging-related charges in children with suspected appendicitis. Ongoing training of emergency department staff is required to ensure protocol compliance.
尽管存在辐射问题，但计算机断层扫描（CT）在许多儿童医院仍是阑尾炎首选的成像方式。我们试图在一家儿童医院通过一种以24小时超声（US）作为主要成像检查的算法来减少阑尾炎的CT使用量。
在2011财年末采用了基于超声的疑似阑尾炎诊疗方案。收集了实施前12个月和实施后24个月的数据。根据每年阑尾切除术的数量对成像检查的使用情况和费用进行调整。在方案实施后的1年多时间里持续对急诊科工作人员进行培训。
2011财年，共安排了644次腹部CT检查和1088次阑尾超声检查，实施了249例腹腔镜阑尾切除术（LA）。方案实施后，2012财年：进行了535次CT检查、1285次超声检查和265例LA；2013财年：进行了330次CT检查、1235次超声检查和236例LA。住院时间从方案实施前到实施后有所缩短（2.57±0.29天对2.15±0.11天），P<0.001。从2011财年到2013财年，每次阑尾切除术的CT检查次数减少了42%（2.43次对1.40次，P<0.001），从方案实施前到实施后减少了30%（2.43次对1.70次，P<0.001）。方案实施前后超声检查次数相应增加了27%（每次阑尾切除术4.11次对5.20次超声检查，P=0.004）。2012财年和2013财年，每次阑尾切除术的CT和超声检查费用分别减少了2253美元和6633美元。
基于方案的超声检查流程显著降低了疑似阑尾炎患儿的CT使用量、辐射暴露以及与成像相关的费用。需要持续对急诊科工作人员进行培训以确保方案的依从性。
