Abstract:
INTRODUCTION:Appendicitis is the most common pediatric emergent surgical condition, with 77,000 American pediatric admissions costing $680 million US annually. Diagnosing appendicitis can be challenging. The prospective Quality Assurance and performance improvement project for suspected aPPEndicitis (QAPPE) study implemented a standardized appendicitis assessment pathway. This current study aims to assess the cost-effectiveness of the QAPPE pathway. METHODS:QAPPE data (February 2018-January 2019) were compared to retrospective data from the year prior (January-December 2017). Patients aged <18, presenting with suspicion of appendicitis were identified using the emergency department patient database. Patients were excluded if they were transferred from an outside center or if appendicitis was not suspected. Study arms were compared using Student's t-test and assessed with standard costing techniques. The Incremental Cost-Effectiveness Ratio (ICER) was determined. Deterministic and probabilistic sensitivity analyses of the model were performed. Effectiveness was assessed by percent of negative appendectomies where alternate diagnosis was made intraoperatively or histologically. Significance was set at p < 0.05. RESULTS:QAPPE (n = 247) and traditional care (n = 234) patients were compared. Traditional care had higher admission frequency and lower pediatric appendicitis score. Demographics between all included patients and those admitted were similar overall. Patient costs were $3656.32 (95% CI $2407-$5250) Canadian (CAD) for QAPPE and $3823.56 (95% CI $2604-$5451) CAD for traditional care. QAPPE was the dominant strategy in the base model and probabilistic simulation found it favored in 64.7% of model iterations with a willingness to pay of $70,000 CAD. CONCLUSION:Using the QAPPE pathway to assess patients with suspected appendicitis reduced costs and improved effectiveness of patient care. LEVEL OF EVIDENCE:2.
journal_name
J Pediatr Surgjournal_title
Journal of pediatric surgeryauthors
Eamer G,Turnbull V,Robinson T,Alfraih Y,Flageole Hdoi
10.1016/j.jpedsurg.2020.09.006subject
Has Abstractpub_date
2020-09-24 00:00:00eissn
0022-3468issn
1531-5037pii
S0022-3468(20)30651-5pub_type
杂志文章abstract:BACKGROUND:Tracheal occlusion (TO) promotes fetal lung growth through an increase in intraluminal pressure. Although evidence suggests that fetal TO (FETO) decreases the occurrence of pulmonary hypertension in severe congenital diaphragmatic hernia, controversies on its effect on the pulmonary circulation remain. There...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2012.08.024
更新日期:2013-03-01 00:00:00
abstract::The authors report experience with 2 neonates with the unusual combination of intrathoracic stomach and Marfan's syndrome. ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章,评审
doi:10.1016/s0022-3468(03)00588-8
更新日期:2003-11-01 00:00:00
abstract:PURPOSE:Pediatric surgeon performed bedside ultrasound (PSPBUS) is a targeted examination that is diagnostic or therapeutic. The aim of this paper is to review literature involving PSPBUS. METHODS:PSPBUS practices reviewed in this paper include central venous catheter placement, physiologic assessment (volume status a...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章,评审
doi:10.1016/j.jpedsurg.2018.04.040
更新日期:2018-11-01 00:00:00
abstract:BACKGROUND:Congenital diaphragmatic hernia (CDH) affects 1 in 3000 live births. Modern management strategies include delayed repair of the diaphragm to permit pre-operative optimization of cardiorespiratory status. We describe a cohort of neonates in whom early emergency operative intervention was required for potentia...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2016.09.012
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:Ovarian immature teratomas (ITs) are relatively rare among all pediatric ovarian tumors. The histological grading for ovarian ITs, which ranges from 1 to 3, is based on the proportion of immature neuroepithelial component. Higher-grade ITs in adults are treated as malignant neoplasms and require adjuvant che...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2019.04.037
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:Meconium peritonitis is a sterile chemical peritonitis resulting from intrauterine bowel perforation. With the development of neonatal care, the prognosis of meconium peritonitis improved much. We report our clinical experience. METHODS:The medical records of patients with meconium peritonitis admitted to t...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2007.07.006
更新日期:2007-11-01 00:00:00
abstract:BACKGROUND:During recovery from intestinal ischemic injury, there is rapid growth of intestinal epithelia with regeneration of damaged villi. This study examines the effects of heparin-binding EGF-like growth factor (HB-EGF) on the recovery of intestinal epithelial cells exposed to hypoxia. METHODS:The cytoprotective ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(98)90517-6
更新日期:1998-07-01 00:00:00
abstract:BACKGROUND:Sclerotherapy is a commonly utilized treatment for rectal prolapse in children. This study systematically evaluates the effectiveness and complications of various sclerosing agents in treating pediatric rectal prolapse. METHODS:After protocol registration (CRD-42018088980), multiple databases were searched....
journal_title:Journal of pediatric surgery
pub_type: 杂志文章,meta分析
doi:10.1016/j.jpedsurg.2019.01.033
更新日期:2019-05-01 00:00:00
abstract::According to Gitlin, alpha-fetoprotein (AFP), albumin, prealbumin, alpha-1-antitrypsin and transferrin are normal products of the human yolk sac. They are expected to reappear in human endodermal sinus tumor (yolk sac tumor). The synthesis of alpha-fetoprotein and other serum proteins by human endodermal sinus tumor w...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(78)80207-3
更新日期:1978-02-01 00:00:00
abstract::A case of carcinoma of the breast in a child of seven is reported. This is a rare condition that behaves differently compared to the adult type. Because of this, a less radical approach is usually indicated. ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(81)80122-4
更新日期:1981-02-01 00:00:00
abstract:UNLABELLED:With the need for physicians to help control the rising cost of health care, consideration should be made, when appropriate, to shift more expensive inpatient care (IPC) to the less costly home care (HC) setting. The management of ruptured appendicitis (RA) includes appendectomy and intravenous (IV) antibiot...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/0022-3468(94)90327-1
更新日期:1994-02-01 00:00:00
abstract:PURPOSE:Few studies have focused on the behavior of rhabdoid tumor (RT) in the fetus and neonate. The purpose of this review is to show that perinatal RTs are associated with unusual findings and a poor prognosis. METHODS:The author conducted a 40-year systematic review of the literature. Clinical presentation, pathol...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章,评审
doi:10.1016/j.jpedsurg.2009.12.011
更新日期:2010-03-01 00:00:00
abstract::A case of pyriform sinus cyst and fistula presenting in the neonatal period is described. Endoscopic cannulation of the fistula tract was used to confirm the diagnosis and to simplify the resection. ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/0022-3468(92)90483-n
更新日期:1992-12-01 00:00:00
abstract:BACKGROUND:Despite increased utilization of robotic-assisted surgery in the pediatric population during the past decade, reports of comparative analysis between robotic surgery and laparoscopic surgery are lacking. Our aim was to evaluate outcomes between pediatric robotic-assisted cholecystectomy (RC) and laparoscopic...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2020.11.013
更新日期:2020-11-20 00:00:00
abstract::Although the survival for infants with abdominal wall defects (AWD) has dramatically improved, agreement on the optimum surgical approach has not been reached. From October 1970 through March 1983, 31 neonates with gastroschisis and 14 neonates with omphalocele were treated. Reduction of the herniated viscera with pri...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(83)80010-4
更新日期:1983-12-01 00:00:00
abstract::Pancreaticopleural fistula resulting in a chronic pleural effusion is a rare complication of pancreatic duct disruption. We describe the presentation and management of 2 children with pancreaticopleural fistulas. Pleural fluid amylase concentration and contrast computed tomography were sufficient to establish the diag...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2005.11.082
更新日期:2006-03-01 00:00:00
abstract::Numerous factors have been advocated as being paramount to the development of necrotizing enterocolitis (NEC) including hypoxia, abnormal bacterial flora, and by products of enteral feedings. In an effort to better understand mechanisms involved at the level of the intestinal mucosal barrier the authors have chosen th...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(97)90598-4
更新日期:1997-03-01 00:00:00
abstract::Twenty-four children with postoperative chylothorax were encountered among 1,264 consecutive thoracic operations over a 7-year period and form the basis of this study. Chylothorax was caused by direct lesion to the thoracic duct or lymphatic vessels in 17 patients and was associated with superior vena cava (SVC) obstr...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/0022-3468(91)90696-q
更新日期:1991-05-01 00:00:00
abstract:BACKGROUND/PURPOSE:Fulminant necrotizing enterocolitis (NEC) may result in extensive bowel necrosis. Resection of involved segments may result in short bowel syndrome. Multiple stomas result in complications and further loss of intestinal length with closure. METHODS:Two patients with extensive multisegmental NEC were...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(00)90004-6
更新日期:2000-02-01 00:00:00
abstract:PURPOSE:SIX2 and CITED1 are transcriptional regulators that specify self-renewing nephronic progenitor cells of the embryonic kidney. We hypothesized that SIX2, which promotes and maintains this stem cell population, and CITED1 remain active in Wilms' tumor (WT). METHODS:To evaluate expression domains and the pathogen...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2012.03.034
更新日期:2012-06-01 00:00:00
abstract:BACKGROUND/PURPOSE:Necrotizing enterocolitis (NEC) is a severe intestinal disease that primarily affects premature babies, leading to high mortality and morbidity. Probiotics represent an important alternative prophylaxis for NEC but its mechanism of action is poorly understood. Moreover, intestinal and liver-type fatt...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2014.07.007
更新日期:2015-04-01 00:00:00
abstract::In the Soave procedure for Hirschsprung's disease, the mucosectomy of the aganglionic segment of colon is performed transabdominally. The authors describe an innovative modification of the standard Soave procedure, in which a transanal mucosectomy is performed as the abdominal incision is made. The transanal mucosecto...
journal_title:Journal of pediatric surgery
pub_type: 临床试验,杂志文章
doi:10.1016/s0022-3468(96)90249-3
更新日期:1996-09-01 00:00:00
abstract::A polyethylene glycol electrolyte solution was evaluated as a mechanical bowel preparation prior to surgery in an outpatient setting. Twelve children underwent outpatient bowel preparation (OPBP) prior to a variety of surgical procedures. The technique was well tolerated and consistently produced a well-prepared intes...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(89)80725-0
更新日期:1989-07-01 00:00:00
abstract:INTRODUCTION:In a previous prospective randomized trial, we found a once-a-day regimen of ceftriaxone and metronidazole to be an efficient, cost-effective treatment for children with perforated appendicitis. In this study, we evaluated the safety of discharging patients to complete an oral course of antibiotics. METHO...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jpedsurg.2010.02.090
更新日期:2010-06-01 00:00:00
abstract::A case report of a neonate with pulmonary arteriovenous malformation is described. The anomaly was prenatally diagnosed, and family history was positive for Rendu-Osler-Weber syndrome. Because neurologic symptoms developed during the second week of life, surgical resection was deemed the best curative option to avoid ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2005.11.043
更新日期:2006-02-01 00:00:00
abstract:BACKGROUND/PURPOSE:Moderate to severe hereditary spherocytosis (HS) is treated with splenectomy. However, total splenectomy leads to decreased immunologic function with the risk of overwhelming postsplenectomy sepsis. Splenic preservation is postulated as a method to avoid this potentially fatal complication. Although ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2010.01.037
更新日期:2010-08-01 00:00:00
abstract::The offspring of pregnant Sprague-Dawley rats exposed to nitrofen on gestational day 9.5 develop left-sided congenital diaphragmatic hernia (CDH). Twenty-four hours after treatment, on day 10.5, supravital staining with Nile blue sulfate and histological examination showed bilateral excessive cell death in cervical so...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/0022-3468(95)90589-8
更新日期:1995-02-01 00:00:00
abstract:BACKGROUND/PURPOSE:Selective mesenteric ischemia may result from activation of the renin-angiotensin system during periods of shock and is implicated in the pathogenesis of neonatal necrotizing enterocolitis (NEC). We investigated the effectiveness of captopril, an angiotensin-converting enzyme inhibitor, in reducing t...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2007.10.022
更新日期:2008-02-01 00:00:00
abstract::Giant cavernous hemangiomas in newborns and infants can present with life-threatening complications. Although some modes of therapy are effective, there is a significant associated morbidity and mortality. The author reports two cases of complicated giant cavernous hemangiomas treated successfully with intermittent pn...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(87)80004-0
更新日期:1987-01-01 00:00:00
abstract::Thoracic outlet syndrome (TOS) is extremely rare in children. Only several pediatric cases have been reported, and all presented with neurologic symptoms. The authors report on a 6-year-old boy with an asymptomatic left subclavian artery aneurysm caused by compression of the subclavian artery by an anomalous first rib...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1053/jpsu.2002.34483
更新日期:2002-08-01 00:00:00