Emergency Department Point‐of‐Care Ultrasonography Can Reduce Length of Stay in Pediatric Appendicitis: A Retrospective Review

Abstract

Objectives-Appendicitis is the most common pediatric surgical emergency. Ultrasonography is recommended as first-line imaging for appendicitis in children; however, this is often followed by more advanced imaging. Our goal was to determine if point-of-care ultrasonography (POCUS) could reduce cost and length-of-stay (LOS) in suspected pediatric appendicitis.Methods-We performed a chart review of patients presenting to our pediatric emergency department (ED) from August 1, 2017 to June 30, 2019 who had imaging for appendicitis. We compared cost and LOS for patients who received POCUS to those who had magnetic resonance imaging (MRI) as first-line imaging, which is standard at our institution.Results-We identified 695 visits of 685 unique patients. Patients who received POCUS (n = 209) had a significantly shorter mean LOS (274 minutes) in the ED compared to patients who did not (317 minutes, P <.001). This was true regardless of the month of their visit. The POCUS group was younger, less likely to have right lower quadrant pain/tenderness, less likely to be admitted, and less likely to have appendicitis than the MRI group. Average appendix imaging cost per patient was lower in the POCUS group at $1308 compared to the MRI group at $1371 (P <.001), although patients who had both POCUS and MRI (n = 102) had the highest average imaging costs ($2010).Conclusion-POCUS can reduce LOS and imaging cost in suspected pediatric appendicitis. Further study is warranted to determine which patients benefit the most from POCUS and whether the results are applicable in other settings.

Implementing Point‐of‐Care Ultrasound for Acute Scrotal Pain in the Pediatric Emergency Department

“…Hence, for pediatric patients brought to the ED with scrotal pain, a prompt ED flow, from diagnostic testing to surgical or manual detorsion, is paramount 3,11 . To reduce unnecessary delays in ED, the use of point‐of‐care ultrasound (POCUS), which can be quickly performed by the ED physician, has been increasing and being investigated recently in the same manner as other pediatric emergencies, including intussusception, acute appendicitis, and infantile hypertrophic pyloric stenosis 12–17 . Mori et al reported high sensitivity and specificity for diagnosing TT using POCUS 13 .…”

“…3,11 To reduce unnecessary delays in ED, the use of pointof-care ultrasound (POCUS), which can be quickly performed by the ED physician, has been increasing and being investigated recently in the same manner as other pediatric emergencies, including intussusception, acute appendicitis, and infantile hypertrophic pyloric stenosis. [12][13][14][15][16][17] Mori et al reported high sensitivity and specificity for diagnosing TT using POCUS. 13 Koppel et al reported advantages, such as a shortened ED length of stay (EDLOS), when using POCUS as a confirmatory test for surgery.…”