Imaging Stewardship for the diagnosis of pediatric appendicitis: Improved ultrasound performance can decrease emergency department length of stay

When ultrasound (US) is non-diagnostic in pediatric patients being evaluated for appendicitis, additional imaging may be required, which incurs delays and increased cost in diagnosis. Our baseline diagnostic rate of US for appendicitis was 27.1 % and was lower for patients with moderate pediatric appendicitis scores (PAS). Due to poor US performance, in our original pathway, patients with moderate PAS underwent magnetic resonance imaging (MRI) initially, resulting in increased emergency department length of stay (ED LOS).