Department of Radiology, Mayo Clinic Rochester, 200 First St. SW, Rochester, MN, 55905, USA.
Department of Radiology, University of California San Diego, San Diego, CA, USA.
Pediatr Radiol. 2021 Feb;51(2):265-272. doi: 10.1007/s00247-020-04820-z. Epub 2020 Sep 9.
Pediatric patients who underwent appendiceal US and received an equivocal interpretation had poorer clinical outcomes and higher medical costs compared to those to whom a definitive interpretation was given, either positive or negative. In an effort to reduce equivocal interpretations, we educated our group on the importance of increasing determinacy and encouraged the use of a reporting template with a definitive impression.
We hypothesized that educational sessions and implementation of an optional reporting template with only a definitive impression would reduce equivocal reporting and improve clinical outcomes without negatively impacting US diagnostic performance.
We retrospectively reviewed the charts of all patients <18 years old at Mayo Clinic Rochester whose initial evaluation for acute appendicitis was a US in the 3-year period following educational sessions and template implementation. All studies were interpreted by board-certified fellowship-trained pediatric radiologists. We performed statistical analysis to compare the pre- and post-implementation cohorts.
Following intervention, the rate of equivocal US interpretations was reduced from 23.7% to 9.3% (P<0.001). For studies with a definitive interpretation, measures of diagnostic performance of appendiceal US were similar for the pre- and post-implementation groups. US performance parameters were independent of appendiceal visualization. Follow-up CT utilization decreased from 18.7% to 8.9% (P<0.001). The negative laparotomy rate resulting from false-positive US interpretations remained low (6.8% vs. 5.0%, P=0.31).
Following education sessions and implementation of an appendiceal US reporting template encouraging definitive reporting, equivocation was reduced, excellent diagnostic performance was maintained, follow-up CT utilization was reduced, and a low negative laparotomy rate was preserved.
与获得明确解读（阳性或阴性）的患儿相比，接受阑尾超声检查且解读结果不确定的儿科患者临床结局更差，医疗费用更高。为了减少不确定的解读，我们向团队强调了提高确定性的重要性，并鼓励使用带有明确印象的报告模板。
我们假设教育课程和实施仅带有明确印象的可选报告模板将减少不确定的报告，并改善临床结局，而不会对超声诊断性能产生负面影响。
我们回顾性分析了梅奥诊所罗切斯特院区在教育课程和模板实施后的 3 年期间，所有年龄<18 岁的急性阑尾炎初始评估为超声检查的患者的病历。所有研究均由具有董事会认证的儿科放射学研究员解读。我们进行了统计分析，以比较实施前后的队列。
干预后，不确定的超声解读率从 23.7%降至 9.3%（P<0.001）。对于具有明确解读的研究，阑尾超声的诊断性能测量值在实施前后的组间相似。超声性能参数与阑尾可视化无关。随访 CT 使用率从 18.7%降至 8.9%（P<0.001）。由于假阳性超声解读导致的阴性剖腹率仍然较低（6.8%比 5.0%，P=0.31）。
在进行教育课程和实施鼓励明确解读的阑尾超声报告模板后，不确定性减少，保持了出色的诊断性能，减少了随访 CT 的使用，保持了较低的阴性剖腹率。
