Does the implementation of a pediatric appendicitis pathway promoting ultrasound work outside of a children's hospital?

BACKGROUND: Efficacy of care pathways for pediatric appendicitis is well established in children's hospitals, but not in community Emergency Departments (EDs).

METHODS: A diagnostic pathway combining the Pediatric Appendicitis Score (PAS) with selective ultrasound was implemented. The charts of 2201 pediatric patients seen at four general EDs before and after implementation were retrospectively reviewed, identifying 611 children seriously considered for appendicitis.

RESULTS: There were no cases of missed appendicitis within the pathway cohort (0/72). Low-PAS children on pathway had fewer computed tomography (CT) scans (0% vs. 21%; p < 0.02). Moderate-PAS patients also had a reduced CT-first rate (2.4% vs. 23%; p < 0.01). However, pathway adoption in 2016 was only 24%. Correct pathway application would have avoided 58 ultrasounds and 17 CTs over three months (annual savings $281,276).

CONCLUSION: A pediatric appendicitis pathway is safe, rules out low suspicion patients without imaging, and is cost effective in a general hospital setting.