An evidence-based clinical protocol for diagnosis of acute appendicitis decreased the use of computed tomography in children.
OBJECTIVE
The increased use of computed tomography (CT) to diagnose appendicitis in children has led to a concern for the possibility of increased CT-related cancer morbidity. We designed a clinical protocol for the diagnosis and treatment of appendicitis in children in an attempt to decrease the use of CT scans at our institution.


METHODS
Patients who had surgical consultation for suspected appendicitis were placed on the clinical protocol. Data concerning diagnosis and treatment were collected prospectively. Retrospective data from patients admitted to our institution with acute appendicitis before the clinical protocol were collected as historical controls.


RESULTS
One hundred twelve patients were diagnosed and treated by our protocol between June and November 2009. Of these, 100 patients underwent an appendectomy for acute appendicitis. They were compared with 146 patients from 2007. In-house CT use decreased from 71.2% to 51.7% (P = .01). Preoperative ultrasound use increased from 2.7% to 21% (P < .001). The negative appendectomy rate increased (6.8% vs 11%, P = .25).


CONCLUSIONS
Our findings suggest that the implementation of an evidence-based clinical protocol for the diagnosis and treatment of acute appendicitis in children may safely decrease the use of CT scans and increase the use of ultrasound.
Division of Pediatric Surgery, The Children's Hospital of Alabama, Birmingham, AL 35233, USA.
Obinna O
OO
Adibe
Sejal R
SR
Amin
Erik N
EN
Hansen
Albert J
AJ
Chong
Lena
L
Perger
Richard
R
Keijzer
Oliver J
OJ
Muensterer
Keith E
KE
Georgeson
Carroll M
CM
Harmon
D000293:Adolescent; D000328:Adult; D001062:Appendectomy / Q000379:methods / Q000706:statistics & numerical data; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009381:Neoplasms, Radiation-Induced / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000706:statistics & numerical data*; D014463:Ultrasonography