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Leveraging the Combined Predictive Value of Ultrasound and Laboratory Data to Reduce Radiation Exposure and Resource Utilization in Children with Suspected Appendicitis
Leveraging the Combined Predictive Value of Ultrasound and Laboratory Data to Reduce Radiation Exposure and Resource Utilization in Children with Suspected Appendicitis
- Source :
- The Journal of surgical research. 257
- Publication Year :
- 2020
-
Abstract
- Previous investigation has shown that the combined predictive value of white blood cell count and ultrasound (US) findings to be superior to either alone in children with suspected appendicitis. The purpose of this study was to evaluate the impact of a diagnostic clinical pathway (DCP) leveraging the combined predictive value of these tests on computed tomography (CT) utilization and resource utilization.Retrospective cohort study comparing 8 mo of data before DCP implementation to 18 mo of data following implementation. The pathway incorporated decision-support for disposition (operative intervention, observation, or further cross-sectional imaging) based on the combined predictive value of laboratory and US data (stratifying patients into low, moderate, and high-risk groups). Study measures included CT and magnetic resonance imaging utilization, imaging-related cost, time to appendectomy, and negative appendectomy rate.Ninety-seven patients in the preintervention period were compared with 319 patients in the postintervention period. Following DCP implementation, CT utilization decreased by 86% (21% versus 3%, P 0.001). Mean time to appendectomy decreased from 8.5 to 7.2 h (P 0.001), and the negative appendectomy rate remained unchanged (5% versus 4%, P = 0.54). Magnetic resonance imaging utilization increased following pathway implementation (1% versus 7%, P = 0.02); however, median imaging-related cost was significantly lower in the postimplementation period ($283/case to $270/case, P = 0.002) CONCLUSIONS: In children with suspected appendicitis, implementation of a DCP leveraging the combined predictive value of white blood cell and US data was associated with a reduction in CT utilization, time to appendectomy, and imaging-related cost.
- Subjects :
- Male
medicine.medical_specialty
Adolescent
Unnecessary Procedures
Risk Assessment
Time-to-Treatment
03 medical and health sciences
Leukocyte Count
Young Adult
0302 clinical medicine
Clinical pathway
Predictive Value of Tests
medicine
Appendectomy
Humans
Child
Retrospective Studies
Ultrasonography
medicine.diagnostic_test
business.industry
Ultrasound
Magnetic resonance imaging
Retrospective cohort study
Radiation Exposure
Appendicitis
Predictive value
Magnetic Resonance Imaging
Radiation exposure
030220 oncology & carcinogenesis
Critical Pathways
030211 gastroenterology & hepatology
Surgery
Female
Suspected appendicitis
Radiology
business
Tomography, X-Ray Computed
Resource utilization
Subjects
Details
- ISSN :
- 10958673
- Volume :
- 257
- Database :
- OpenAIRE
- Journal :
- The Journal of surgical research
- Accession number :
- edsair.doi.dedup.....05321fc9fdee7c0ac5d51ea39b82a414