Mandatory imaging in the work-up of children suspected of having appendicitis reduces the rate of unnecessary surgeries
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In brief
In brief
Study evaluates impact of 2010 Dutch appendicitis guideline requiring mandatory preoperative imaging (ultrasound first, CT/MRI if inconclusive) in pediatric patients. Cohort comparison of 748 children shows ultrasound use increased from 46% to 95% post-implementation, examining whether guideline reduced unnecessary appendectomies.
Written by the GCMD Library team from the article.
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