Appendicitis 2000: Variability in practice, outcomes, and resource utilization at thirty pediatric hospitals

Newman, Kurt D.; Ponsky, Todd A.; Kittle, Kory; Dyk, Lorna; Throop, Cheri; Gieseker, Karen E.; Sills, Marion R.; Gilbert, James C.

doi:10.1053/jpsu.2003.50111

Cited by 208 publications

(128 citation statements)

References 14 publications

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“…Rate of appendiceal perforation increases from less than 2% when appendectomy is performed within 36 hours of symptom onset to 5% after this time period 3 . Appendiceal perforation increases 10 times the rate of postoperative complications 2,5,6 . Wound infection remains the most common reported complication after appendectomy and its incidence varies depending on the stage of appendicitis, patient age and physiologic condition, and whether the appendectomy is laparoscopic or open.…”

Section: Discussionmentioning

confidence: 99%

Appendectomy: comparative study between a public and a private hospital

Coelho¹,

Fernandes²,

Cortiano³

et al. 2010

Rev. Assoc. Med. Bras.

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Section: Discussionmentioning

confidence: 99%

Appendectomy: comparative study between a public and a private hospital

Coelho¹,

Fernandes²,

Cortiano³

et al. 2010

Rev. Assoc. Med. Bras.

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“…Features suggestive of previous appendicitis 11 were noted so as to include interval appendicectomies in the positive result. Appendices were defined as perforated on the basis of histological demonstration, not by operative findings.…”

Section: Methodsmentioning

confidence: 99%

Ultrasonography aids decision-making in children with abdominal pain

Scammell

Lansdale

Sprigg

et al. 2011

annals

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The prompt diagnosis of appendicitis in children is made difficult not only by the challenging nature of a paediatric history and examination but also by the protean behaviour of the symptoms. We know that almost half of children will present with some atypical features of appendicitis and that one quarter will have primarily atypical features.1 However, delay in diagnosis correlates with an increased risk of perforation.2 In the uS this diagnostic challenge has resulted in appendicitis being the second most common diagnosis involved in paediatric emergency medicine malpractice claims, the most common being meningitis. Diagnostic error accounted for 39% of these claims. 3While we are still taught to consider appendicitis as a clinical diagnosis, over the past two decades ultrasonography and computed tomography (CT) have emerged as tools to assist in this diagnostic challenge. There has been much debate within the literature over which imaging modality is superior. [4][5][6] Graded compression sonography offers a rapid, non-invasive and inexpensive means of imaging an inflamed appendix. The examination can be performed at the site of greatest tenderness, enabling correlation of imaging findings with patient symptoms, and in this way it is dynamic. 7 For these reasons, within the uK, it has become the primary imaging modality in the diagnosis of acute appendicitis. Nevertheless, its role in the management of a child with acute abdominal pain varies between different institutions and its use extends beyond specialist paediatric centres. Given the operator-dependent nature of this imaging modality, it is essential that we audit departmental accuracy. However, few institutions have published such figures in the uK literature. [8][9][10] This study aims to demonstrate the value of ultrasonography as a tool in the decision-making process by providing the fundamental rates of negative appendicectomy and perforation for comparison and measures of the accuracy of ultrasonography for this regional unit. MethodsThis was a cross-sectional retrospective study using three routine hospital databases. A search was performed on the theatre information database for appendicectomies and these were then matched with corresponding pathological reports on appendix specimens. The radiology information system returned a database of reports on abdominal ultra- Although regular clinical assessment of the acute abdomen is considered best practice, ultrasonography confirming the presence of appendicitis will add to the decision-making process. The aim of this study was to assess the accuracy of ultrasonography and its usefulness in diagnosing acute appendicitis in a regional paediatric surgical institution. METHODS Retrospectively and in this order, radiology, theatre and histopathology databases were searched for patients who had presented with acute abdominal pain, patients who had undergone an appendicectomy and all appendix specimens over a two-year period. The databases were cross-referenced against each other. RESULTS A total of 273 n...

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“…1,3,[9][10][11][12] In addition, potential overuse of CT is problematic given the risks of radiation exposure. It is estimated that 1 radiation-induced malignancy may result from every 700 abdominal CT scans obtained in young males, and the risks may be even higher in young females.…”

mentioning

confidence: 99%

Implementation of Electronic Clinical Decision Support for Pediatric Appendicitis

Kharbanda¹,

Madhok²,

Krause³

et al. 2016

Pediatrics

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BACKGROUND AND OBJECTIVE: Computed tomography (CT) and ultrasound (US) are commonly used in patients with acute abdominal pain. We sought to standardize care and reduce CT use while maintaining patient safety through implementation of a multicomponent electronic clinical decision support tool for pediatric patients with possible appendicitis. METHODS: We conducted a quasi-experimental study of children 3 to 18 years old who presented with possible appendicitis to the pediatric emergency department (ED) between January 2011 and December 2013. Outcomes were use of CT and US. Balancing measures included missed appendicitis, ED revisits within 30 days, appendiceal perforation, and ED length of stay. RESULTS: Of 2803 patients with acute abdominal pain over the 3-year study period, 794 (28%) had appendicitis and 207 (26.1% of those with appendicitis) had a perforation. CT use during the 10-month preimplementation period was 38.8% and declined to 17.7% by the end of the study (54% relative decrease). For CT, segmented regression analysis revealed that there was a significant change in trend from the preimplementation period to implementation (monthly decrease –3.5%; 95% confidence interval: –5.9% to –0.9%; P = .007). US use was 45.7% preimplementation and 59.7% during implementation. However, there was no significant change in US or total imaging trends. There were also no statistically significant differences in rates of missed appendicitis, ED revisits within 30 days, appendiceal perforation, or ED length of stay between time periods. CONCLUSIONS: Our electronic clinical decision support tool was associated with a decrease in CT use while maintaining safety and high quality care for patients with possible appendicitis.

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Appendicitis 2000: Variability in practice, outcomes, and resource utilization at thirty pediatric hospitals

Cited by 208 publications

References 14 publications

Appendectomy: comparative study between a public and a private hospital

Appendectomy: comparative study between a public and a private hospital

Ultrasonography aids decision-making in children with abdominal pain

Implementation of Electronic Clinical Decision Support for Pediatric Appendicitis

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