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Am J Surg. 2015 May;209(5):896-900; discussion 900. doi: 10.1016/j.amjsurg.2014.12.029. Epub 2015 Feb 24.

Improving ultrasound quality to reduce computed tomography use in pediatric appendicitis: the Safe and Sound campaign.

Author information

1
Department of Surgery, University of Washington, 1959 NE Pacific Street, Box 356410, Seattle, WA 98101, USA; Surgical Outcomes Research Center, University of Washington, 1959 NE Pacific Street, Box 356410, Seattle, WA 98101, USA; CHASE Alliance, University of Washington, 1959 NE Pacific Street, Box 356410, Seattle, WA 98101, USA. Electronic address: mkotagal@uw.edu.
2
Department of Surgery, University of Washington, 1959 NE Pacific Street, Box 356410, Seattle, WA 98101, USA; Department of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA.
3
Department of Radiology, Seattle Children's Hospital, Seattle, WA, USA.
4
Department of Radiology, Swedish Medical Center, Seattle, WA, USA.
5
Department of Emergency Medicine, Providence Centralia Hospital, Centralia, WA, USA.
6
Department of Radiology, Mary Bridge Children's Hospital, Tacoma, WA, USA.
7
Department of Surgery, Madigan Army Medical Hospital, Tacoma, WA, USA.
8
Department of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA.

Abstract

BACKGROUND:

Safety concerns about the use of radiation-based imaging such as computed tomography (CT) in children have resulted in national recommendations to use ultrasound (US) for the diagnosis of appendicitis when possible. We evaluated the trends in CT and US use in a statewide sample and the accuracy of these modalities.

METHODS:

Patients less than or equal to 18 years undergoing appendectomy in Washington State from 2008 to 2013 were evaluated for preoperative US/CT use, as well as imaging/pathology concordance using data from the Surgical Care and Outcomes Assessment Program.

RESULTS:

Among 3,353 children, 98.3% underwent preoperative imaging. There was a significant increase in the use of US first over the study period (P < .001). The use of CT at any time during the evaluation decreased. Despite this, in 2013, over 40% of the children still underwent CT imaging. Concordance between US imaging and pathology varied between 40% and 75% at hospitals performing greater than or equal to 10 appendectomies in 2013. Over one third (34.9%) of CT scans performed in the evaluation of children with appendicitis were performed after an indeterminate US.

CONCLUSIONS:

Although the use of US as the first imaging modality to diagnose pediatric appendicitis has increased over the past 5 years, over 40% of children still undergo a CT scan during their preoperative evaluation. Causality for this persistence of CT use is unclear, but could include variability in US accuracy, lack of training, and lack of awareness of the risks of radiation-based imaging. Developing a campaign to focus on continued reduction in CT and increased use of high-quality US should be pursued.

KEYWORDS:

Appendicitis; Computed tomography; Radiology; Ultrasound

PMID:
25771132
PMCID:
PMC4426027
DOI:
10.1016/j.amjsurg.2014.12.029
[Indexed for MEDLINE]
Free PMC Article

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