Improving ultrasound for appendicitis through standardized reporting of secondary signs

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 pre- and posttemplate. Results We identified 387 patients in the pre-template period and 483 patients in the posttemplate period. In the post-template 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.

To determine validity of ultrasound in predicting acute appendicitis among children keeping histopathology as gold standard

“…Depend on policy of your hospital as in our setup US scan is for every suspected case of appendicitis (24hr available), trained staff as our technical operator which are more efficient in visualization of appendix and then the surgeon job to help along during whole process. Similarly, authors have shown that specialized pediatric sonographers identified the appendix more often than the general sonographer [ 1 , 20 , 21 ].…”

“…Zero radiation to children, quick, more efficient and easy excess make ultrasound one of leading choice of diagnosis in appendicitis as compared to CT or MRI [ 1 ]. Acute abdominal pain is a common cause for surgical consultation in pediatric gastroenterology emergency [ 2 , 3 ].…”

Analysis of the predictive value of clinical and sonographic variables in children with suspected acute appendicitis using decision tree algorithms

“…Cases where the appendix cannot be identified have historically been considered non‐diagnostic or equivocal. These cases are made more meaningful with the exclusion, or recognition and evaluation of secondary signs of appendicitis . Secondary signs such as mesenteric inflammation, free fluid and prominent lymph nodes can suggest the presence of an inflamed appendix .…”

“…These cases are made more meaningful with the exclusion, or recognition and evaluation of secondary signs of appendicitis. 8 Secondary signs such as mesenteric inflammation, free fluid and prominent lymph nodes can suggest the presence of an inflamed appendix. 9 The approach to appendicitis ultrasound is changing with Funding: None.…”

EFSUMB Position Paper: Recommendations for Gastrointestinal Ultrasound (GIUS) in Acute Appendicitis and Diverticulitis

“…A structured training program, the use of standardized ultrasound reporting templates and regular feedback enhance the accuracy of ultrasound and dramatically reduce the number of non-diagnostic ultrasound scans [8, 77, 108, 113 -118]. In this way, the use of CT for patients with an equivocal ultrasound result, costs and admission for observation can be reduced [114].…”