A Standardized Ultrasound Reporting Template for Pediatric Appendicitis Improves Diagnostic Rates and Decreases CT Utilization Among Both Pediatric and Non-Pediatric Radiologists: An Analysis of 3539 Patients
*Samuel Miller, *Yuqi Zhang, Michael G Caty, Emily R Christison-Lagay, Robert A Cowles, David H Stitelman, *Thomas R Goodman, *Cicero T Silva, *Beth L Emerson, *Brian Dillon, *Lisa Sagnella, Doruk Ozgediz, *Daniel G Solomon
Yale University School of Medicine, New Haven, CT
Objective: Data suggests that standardized reporting templates for ultrasounds performed to diagnose pediatric appendicitis improve the likelihood of a diagnostic study. To date, these findings have not been reproduced outside of freestanding children’s hospitals. We sought to evaluate the implementation of a standardized reporting tool in a Pediatric Emergency room where overnight/weekend ultrasounds are read by non-pediatric trained radiologists.
Design: Retrospective cohort
Setting: Tertiary referral children’s hospital within an adult general hospital
Patients: 4-16yo evaluated for acute nonperforated appendicitis
Interventions: Institution of a standardized reporting tool
Main Outcome Measures: Rate of diagnostic studies (defined as a visualized appendix with a conclusion about the presence/absence of inflammation), repeat ultrasounds and computed tomography were collect by blinded abstractors.
Results: Between 2013-2018, 3539 individual children were evaluated radiographically for appendicitis (1421 by pediatric radiologists, 2118 by adult radiologists). 4082 US were performed (1765 by pediatric radiologists, 2317 by adult radiologists). Repeat radiographic exams were required 11.6% of the time (7.5% for pediatric radiologists, 14.7% for adult radiologists, p<0.00001). Template utilization improved the rate of diagnostic studies for both pediatric (79.5% vs 83.9%, p=0.07) and adult radiologists (57.1% vs 81.6%, p=0.0001). Template utilization reduced the rate of subsequent CT scan for both groups (6.7% vs 2.8% p=0.006 for pediatric radiologists, 9.0% vs 4.6% p=0.09 for adult radiologists)
Conclusions: This is the first demonstration of the efficacy of a standardized US reporting template to improve the diagnostic rate of US for pediatric appendicitis and reduce the need for CT scans by non-pediatric radiologists. We hope this data will increase the utilization of this tool at our institution, and possibly non-children’s hospitals where US are performed entirely by adult radiologists.
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