Improving ultrasound for appendicitis through standardized reporting of secondary signs

• Type of Material: Article
• Authors: Kristin N. Partain, Emory University; Adarsh U. Patel, Emory University; Curtis Travers, Emory University; Heather L. Short, Emory University; Kiery Braithwaite, Emory University; Jonathan Loewen, Emory University; Kurt Heiss, Emory University; Mehul Raval, Emory University
• Language: English
• Date: 2017-08-01
• Publisher: W B SAUNDERS CO-ELSEVIER INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jpedsurg.2016.11.045
• Title of Journal or Parent Work: JOURNAL OF PEDIATRIC SURGERY
• Volume: 52
• Issue: 8
• Start Page: 1273
• End Page: 1279
• Grant/Funding Information: This research is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. In addition, MVR is supported by the Pediatric Research Alliance, Children’s Healthcare of Atlanta, and the Department of Surgery at Emory University. Funding sources did not have any role in design, implementation, interpretation, or publication of the study.
• Keywords: COMPUTED-TOMOGRAPHY; COST; Secondary signs; Surgery; Appendicitis; Quality improvement; US EXAMINATION; Ultrasound; CHILDRENS HOSPITALS; CT; Science & Technology; Pediatrics; CANCER; MANAGEMENT; Life Sciences & Biomedicine; SUSPECTED APPENDICITIS; DIAGNOSTIC-ACCURACY
• Research Categories: Health Sciences, Pathology; Health Sciences, Oncology; Health Sciences, Medicine and Surgery; Health Sciences, Radiology

Abstract

Objective 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. Methods 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. Results 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. Conclusion 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.