title: Staged imaging pathway for the evaluation of pediatric appendicitis.
abstract: OBJECTIVE
  Despite significant radiation exposure involved with computed tomography (CT) in evaluation of pediatric appendicitis, its use is still widespread. The goal of this study was to assess the effect of a staged imaging pathway for appendicitis to significantly decrease CT use while maintaining diagnostic accuracy.
  
  
  METHODS
  Chart review was performed for patients evaluated for appendicitis over a 12-month period prior to and after pathway implementation.
  
  
  RESULTS
  There was a significant decrease in CT use as initial imaging after implementation of the pathway; 87.1-13.4 % for evaluations positive for appendicitis (decrease 84.6 %, p < 0.0001) and 82.6-9.2 % for evaluations negative for appendicitis (decrease 88.9 %, p < 0.0001). Use of CT during any point in the evaluation decreased from 91.7 to 25.1 % (decrease 72.6 %, p < 0.0001). The negative appendectomy rate was similar; 5.4 % prior, 4.9 % post (p = 0.955). The missed appendicitis rate did not statistically change; 1.1 % prior, 3.7 % post (p = 0.523). The perforation rate was not statistically altered; 6.5 % prior; 9.8 % post (p = 0.421). 350 less patients underwent CT during the year following the pathway.
  
  
  CONCLUSIONS
  The staged imaging pathway resulted in a marked decrease in children exposed to CT without compromising diagnostic accuracy.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Central DuPage Hospital, Winfield, IL, USA. mingtchien@yahoo.com.
authors.forename: Ming
authors.initials: M
authors.lastname: Chien
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Central DuPage Hospital, Winfield, IL, USA.
authors.forename: Arie
authors.initials: A
authors.lastname: Habis
authors.affiliation: Division of Pediatric Surgery, Department of Pediatrics, Central DuPage Hospital, Winfield, IL, USA.
authors.forename: Loretto
authors.initials: L
authors.lastname: Glynn
authors.affiliation: Division of Pediatric Surgery, Department of Pediatrics, Central DuPage Hospital, Winfield, IL, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: O'Connor
authors.affiliation: Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
authors.forename: Tracie L
authors.initials: TL
authors.lastname: Smith
authors.affiliation: Division of Pediatric Radiology, Department of Pediatrics, Central DuPage Hospital, Winfield, IL, USA.
authors.forename: Francis
authors.initials: F
authors.lastname: Prendergast
mesh_terms: D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014463:Ultrasonography / Q000379:methods*
keywords: Appendicitis; Computed tomography; Pediatrics; Ultrasound