The impact of a clinical guideline on imaging children with hypertrophic pyloric stenosis.
OBJECTIVE
The purpose of the study was to evaluate the impact of a clinical pathway on the volume of imaging studies performed in children with suspected clinical diagnosis of hypertrophic pyloric stenosis. The pathway suggested referral to surgeons for clinical evaluation for palpation of the olive prior to ordering imaging studies. Only those children in whom the olive could not be palpated would be referred for imaging, and it was anticipated that imaging volume would be reduced following guideline implementation.


METHODS
The database of the Health Policy and Clinical Effectiveness Department was used to evaluate all patients who had surgery for hypertrophic pyloric stenosis. The presence of a palpable olive and the type of imaging were evaluated both prior to and after the implementation of the clinical guideline.


RESULTS
Prior to the guideline, 85 infants had surgery for pyloric stenosis, with 83 of the 85 (97%) having imaging. After the implementation of the guideline, 90 infants had surgery for pyloric stenosis with 84 of 90 patients imaged (92%). A chi-square analysis demonstrated no significant difference in the percentage of children imaged in the two groups (P = 0.104). Approximately one in five children referred for vomiting were diagnosed with hypertrophic pyloric stenosis.


CONCLUSIONS
No significant change in imaging volume occurred following initiation of a guideline which recommended clinical evaluation for palpation of the olive prior to ordering imaging studies. Multiple factors probably contributed to the lack of demonstrated changes.
Department of Pediatric Radiology, Division of Pediatric Surgery, Center for Health Policy and Clinical Effectiveness, Cincinnati Children's Hospital, University of Cincinnati, 3333 Burnet Ave., Cincinnati, OH 45229, USA.
Kathy Jane
KJ
Helton
Janet L
JL
Strife
Brad W
BW
Warner
Terri L
TL
Byczkowski
Edward F
EF
Donovan
D019091:Critical Pathways; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000000981:diagnostic imaging; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011707:Pyloric Stenosis / Q000000981:diagnostic imaging*; D014463:Ultrasonography