title: Reduced use of computed tomography in patients treated with interval appendectomy after implementing a protocol from a prospective, randomized trial.
abstract: BACKGROUND
  In 2009, we instituted a protocol to standardize care for patients undergoing interval appendectomy based on results from a prospective trial that demonstrated a reduction in the mean number of computed tomography (CT) scans performed. The goal of this study was to determine if our current practice now resulted in fewer CT scans as a result of this trial.
  
  
  METHODS
  A retrospective review of all patients undergoing interval appendectomy for perforated appendicitis from March 2009 to March 2011 was performed. Demographics and outcomes were compared to previously collected data from a retrospective study prior to institution of the protocol and to the prospective trial.
  
  
  RESULTS
  During the study period, 45 patients underwent interval appendectomy. There were no differences in demographics among the three studies. Similar numbers of patients underwent aspiration or percutaneous drainage. There continues to be a significant reduction in the number of CT scans (3.5 ± 2.0 vs. 2.1 ± 1.3, P = 0.0001) and health care visits (7.6 ± 2.8 vs. 4.5 ± 1.4, P = 0.0001) when comparing management prior to the prospective trial to management since its completion.
  
  
  CONCLUSIONS
  A protocol for management of patients undergoing interval appendectomy care results in fewer health care visits and CT scans.
authors.affiliation: Department of Surgery, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO, 64108, USA.
authors.forename: E Marty
authors.initials: EM
authors.lastname: Knott
authors.forename: Priscilla
authors.initials: P
authors.lastname: Thomas
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Sharp
authors.forename: Alessandra C
authors.initials: AC
authors.lastname: Gasior
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002443:Ceftriaxone / Q000627:therapeutic use; D002648:Child; D004322:Drainage / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D002443:Ceftriaxone
references.citation: Arch Surg. 2011 Jun;146(6):660-5
references.pmid: 21339413
references.citation: J Pediatr Surg. 2008 Jun;43(6):977-80
references.pmid: 18558168
references.citation: J Pediatr Surg. 2011 Jun;46(6):1121-5
references.pmid: 21683209
references.citation: J Pediatr Surg. 1980 Aug;15(4):574-6
references.pmid: 7411371
references.citation: J Laparoendosc Adv Surg Tech A. 2006 Jun;16(3):308-11
references.pmid: 16796448
references.citation: J Pediatr Surg. 2008 Jun;43(6):981-5
references.pmid: 18558169
references.citation: Curr Opin Pediatr. 1995 Oct;7(5):601-5
references.pmid: 8541963
references.citation: Fetal Diagn Ther. 2011;29(1):55-63
references.pmid: 21325859
references.citation: J Pediatr Surg. 1998 Sep;33(9):1371-5
references.pmid: 9766356
references.citation: J Am Coll Surg. 2012 Apr;214(4):427-34; discussion 434-5
references.pmid: 22342789
references.citation: Semin Pediatr Surg. 2007 Feb;16(1):34-40
references.pmid: 17210481
references.citation: J Pediatr Surg. 2010 Jan;45(1):236-40
references.pmid: 20105610
references.citation: J Am Coll Surg. 2003 Feb;196(2):212-21
references.pmid: 12595049
references.citation: CJEM. 2006 Nov;8(6):425-32
references.pmid: 17209492
references.citation: J Pediatr Surg. 2008 Dec;43(12):2242-5
references.pmid: 19040944