Improving ultrasound quality to reduce computed tomography use in pediatric appendicitis: the Safe and Sound campaign

American Journal of Surgery
Meera KotagalSafe and Sound Campaign

Abstract

Safety concerns about the use of radiation-based imaging such as computed tomography (CT) in children have resulted in national recommendations to use ultrasound (US) for the diagnosis of appendicitis when possible. We evaluated the trends in CT and US use in a statewide sample and the accuracy of these modalities. Patients less than or equal to 18 years undergoing appendectomy in Washington State from 2008 to 2013 were evaluated for preoperative US/CT use, as well as imaging/pathology concordance using data from the Surgical Care and Outcomes Assessment Program. Among 3,353 children, 98.3% underwent preoperative imaging. There was a significant increase in the use of US first over the study period (P < .001). The use of CT at any time during the evaluation decreased. Despite this, in 2013, over 40% of the children still underwent CT imaging. Concordance between US imaging and pathology varied between 40% and 75% at hospitals performing greater than or equal to 10 appendectomies in 2013. Over one third (34.9%) of CT scans performed in the evaluation of children with appendicitis were performed after an indeterminate US. Although the use of US as the first imaging modality to diagnose pediatric appendicitis has increased over th...Continue Reading

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Citations

Feb 18, 2016·Insights Into Imaging·Gerhard MostbeckCatherine M Owens
Dec 23, 2015·Journal of Magnetic Resonance Imaging : JMRI·Michael D RepplingerDavid J Vanness
Apr 8, 2016·Journal of the American College of Radiology : JACR·Michael D RepplingerElizabeth A Jacobs
Jul 21, 2016·World Journal of Emergency Surgery : WJES·Salomone Di SaverioRoland Andersson
Oct 4, 2016·The Journal of Emergency Medicine·Christine KellerJames V Quinn
Nov 9, 2017·The British Journal of Surgery·H T MalikE Mossialos
May 2, 2017·The Journal of Trauma and Acute Care Surgery·Swathi B ReddyKevin M Schuster
Aug 16, 2016·Postgraduate Medical Journal·Ko-Chin ChenAndrew G Christy
Mar 3, 2021·Canadian Association of Radiologists Journal = Journal L'Association Canadienne Des Radiologistes·Jelena KomanchukGraham Thompson
Jul 26, 2021·The American Journal of Emergency Medicine·Suzanne RobertsJames A Meltzer
Aug 15, 2021·Advances in Surgery·Katherine He, Shawn J Rangel

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