(Ultrasound Review) Using an ultrasound-CT imaging protocol reduced the perforation and negative appendectomy rates in children suspected of having acute appendicitis, according to the results of a study published in the February issue of Pediatrics. Researchers at Miami Children’s Hospital studied the impact of a US-CT imaging protocol by analyzing patient outcomes before and after implementation.
Two patient cohorts were established. Group one consisted of 920 patients admitted for suspected appendicitis before the protocol was implemented. Group two consisted of 418 patients admitted for the same reasons after protocol implementation. The protocol determined that appendectomy without imaging was performed in children with unequivocal clinical presentations. Children with equivocal clinical findings had ultrasound followed by appendectomy when sonography was positive. CT was performed when ultrasound was unsuccessful or findings were equivocal.
Following the imaging protocol implementation, the use of ultrasound progressively decreased as referring doctors realized that the accuracy of CT surpassed that of ultrasound. They reported that several surgeons began to only request CT examination in selected cases. Interestingly, children age 5 or less showed no significant decrease in perforation or negative appendectomy rate. They suggested this might be because of generalized difficulties associated with clinical evaluation and early detection of appendicitis in infants.
Fifty-seven percent of patients in group one had appendicitis, 35% had perforations and 14.7% had negative appendectomies. In group two 78.5% had appendicitis, 15.5% had perforations and 4.1% had negative appendectomies. Comparing the two groups, there was a dramatic reduction in patients with perforations and negative appendectomies following implementation of a US-CT imaging protocol. The authors concluded "because of improved patient management with the use of the imaging protocol, the results of this stud strongly support the use of the US-CT protocol for children with signs and symptoms suspicious, but not diagnostic for, acute appendicitis."
Effect of an imaging protocol on clinical outcomes among pediatric patients with appendicitisGarcia Pena, B et al
Miami Children’s Hospital, Miami, FL
Pediatrics 2002 February; 110:1088-1093
By Ultrasound Review
March 25, 2003
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