Standardized appendiceal ultrasound reporting template improves clinical outcomes

Infographic · Aug 2021 · 1 min read

In brief

Implementation of a standardized ultrasound reporting template with definitive impressions reduced equivocal appendicitis interpretations from 23.7% to 9.3% while maintaining diagnostic accuracy. The intervention decreased follow-up CT utilization by half and preserved low negative laparotomy rates, demonstrating improved clinical outcomes through structured reporting.

Standardized US reporting template reduced equivocal appendicitis interpretations from 23.7% to 9.3% without compromising diagnostic accuracy
Follow-up CT utilization decreased by more than half (18.7% to 8.9%) after implementing definitive reporting guidelines
Negative laparotomy rate remained low (5-7%) despite increased diagnostic certainty, preserving patient safety
Educational intervention plus structured reporting improved clinical outcomes and reduced costs in pediatric appendicitis evaluation
US diagnostic performance was maintained independent of appendiceal visualization when using standardized reporting

Written by the GCMD Library team from the infographic.

A before-and-after flow diagram with a left panel showing a pediatric patient with suspected appendicitis, and a right panel displaying four outcome metrics with downward arrows indicating improvements. The design uses red circles to highlight problem areas in the 'before' state and blue checkmarks to indicate improvements in the 'after' state. Gray bars represent baseline metrics, with percentage values shown in large text.

Abstract

Background

Pediatric patients who underwent appendiceal US and received an equivocal interpretation had poorer clinical outcomes and higher medical costs compared to those to whom a definitive interpretation was given, either positive or negative. In an effort to reduce equivocal interpretations, we educated our group on the importance of increasing determinacy and encouraged the use of a reporting template with a definitive impression.

Objective

We hypothesized that educational sessions and implementation of an optional reporting template with only a definitive impression would reduce equivocal reporting and improve clinical outcomes without negatively impacting US diagnostic performance.

Materials and methods

We retrospectively reviewed the charts of all patients <18 years old at Mayo Clinic Rochester whose initial evaluation for acute appendicitis was a US in the 3-year period following educational sessions and template implementation. All studies were interpreted by board-certified fellowship-trained pediatric radiologists. We performed statistical analysis to compare the pre- and post-implementation cohorts.

Results

Following intervention, the rate of equivocal US interpretations was reduced from 23.7% to 9.3% (P<0.001). For studies with a definitive interpretation, measures of diagnostic performance of appendiceal US were similar for the pre- and post-implementation groups. US performance parameters were independent of appendiceal visualization. Follow-up CT utilization decreased from 18.7% to 8.9% (P<0.001). The negative laparotomy rate resulting from false-positive US interpretations remained low (6.8% vs. 5.0%, P=0.31).

Conclusion

Following education sessions and implementation of an appendiceal US reporting template encouraging definitive reporting, equivocation was reduced, excellent diagnostic performance was maintained, follow-up CT utilization was reduced, and a low negative laparotomy rate was preserved.

The text in the image

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