Partain Kristin N, Patel Adarsh U, Travers Curtis, Short Heather L, Braithwaite Kiery, Loewen Jonathan, Heiss Kurt F, Raval Mehul V
Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
J Pediatr Surg. 2017 Aug;52(8):1273-1279. doi: 10.1016/j.jpedsurg.2016.11.045. Epub 2016 Dec 5.
Our aim was to implement a standardized US report that included secondary signs of appendicitis (SS) to facilitate accurate diagnosis of appendicitis and decrease the use of computed tomography (CT) and admissions for observation.
A multidisciplinary team implemented a quality improvement (QI) intervention in the form of a standardized US report and provided stakeholders with monthly feedback. Outcomes including report compliance, CT use, and observation admissions were compared pretemplate and posttemplate.
We identified 387 patients in the pretemplate period and 483 patients in the posttemplate period. In the posttemplate period, the reporting of SS increased from 5.4% to 79.5% (p<0.001). Despite lower rates of appendix visualization (43.9% to 32.7%, p<0.001) with US, overall CT use (8.5% vs 7.0%, p=0.41) and the negative appendectomy rate remained stable (1.0% vs 1.0%, p=1.0). CT utilization for patients with an equivocal ultrasound and SS present decreased (36.4% vs 8.9%, p=0.002) and admissions for observations decreased (21.5% vs 15.3%, p=0.02). Test characteristics of RLQ US for appendicitis also improved in the posttemplate period.
A focused QI initiative led to high compliance rates of utilizing the standardized US report and resulted in lower CT use and fewer admissions for observation. Study of a Diagnostic Test Level of Evidence: 1.
我们的目标是实施一份包含阑尾炎次要征象（SS）的标准化超声报告，以促进阑尾炎的准确诊断，并减少计算机断层扫描（CT）的使用以及观察性住院治疗。
一个多学科团队以标准化超声报告的形式实施了质量改进（QI）干预，并每月向利益相关者提供反馈。比较了模板使用前和模板使用后的结果，包括报告合规性、CT使用情况和观察性住院治疗情况。
我们在模板使用前阶段确定了387例患者，在模板使用后阶段确定了483例患者。在模板使用后阶段，SS的报告率从5.4%提高到79.5%（p<0.001）。尽管超声检查时阑尾可视化率较低（从43.9%降至32.7%，p<0.001），但总体CT使用率（8.5%对7.0%，p=0.41）和阴性阑尾切除率保持稳定（1.0%对1.0%，p=1.0）。对于超声检查结果不明确且存在SS的患者，CT使用率下降（从36.4%降至8.9%，p=0.002），观察性住院治疗率下降（从21.5%降至15.3%，p=0.02）。在模板使用后阶段，右下腹超声检查对阑尾炎的检测特征也有所改善。
一项有针对性的QI举措导致标准化超声报告的高使用率，并降低了CT的使用和观察性住院治疗率。诊断试验证据水平研究：1级。
