Abstract：
OBJECTIVE:In children, the diagnosis “acute appendicitis” is difficult. In 2010, a new Dutch appendicitis guideline was published with the goal to reduce the negative appendectomy rate. The guideline recommended mandatory imaging (ultrasound first and CT or MRI when inconclusive) before surgery. This study examines whether the negative appendectomy rate in children has declined after the implementation of the guideline and if the number of ionising imaging procedures increased. METHODS:In this cohort study, all consecutive patients aged 17 or younger, with the suspicion of appendicitis were included. Patients were divided into two groups. Those who presented between 2006 and 2010 (before the implementation) and those between 2011 and 2016 (after implementation). RESULTS:In total, 748 children were enrolled, of which 363 children were seen before and 385 children after implementation of the guideline. Before implementation, 46% of the children with acute appendicitis underwent preoperative ultrasound compared with 95% in the post implementation group, p < 0.001. Any imaging was performed in 51% and 100%, respectively, p < 0.001. The percentage of negative appendectomy before implementation was 13% and 2.7% after implementation, p < 0.001. There was no significant increase in the number of CT scans before and after the implementation of the guideline, 3.6% versus 6.0%, respectively, p = 0.126. There was no increase in direct medical costs. CONCLUSIONS:Mandatory preoperative imaging in children with the suspicion of acute appendicitis results in a significant decrease in negative appendectomies with no increase in the number of CT scans and without a substantial increase in costs.
journal_name
J Pediatr Surgjournal_title
Journal of pediatric surgeryauthors
de Castro SMM,Geerdink TH,Macco S,van Veen RN,Jensch S,Vrouenraets BCdoi
10.1016/j.jpedsurg.2018.02.050subject
Has Abstractpub_date
2018-10-01 00:00:00pages
2028-2031issue
10eissn
0022-3468issn
1531-5037pii
S0022-3468(18)30105-2journal_volume
53pub_type
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journal_title：Journal of pediatric surgery
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journal_title：Journal of pediatric surgery
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journal_title：Journal of pediatric surgery
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journal_title：Journal of pediatric surgery
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journal_title：Journal of pediatric surgery
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journal_title：Journal of pediatric surgery
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journal_title：Journal of pediatric surgery
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