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Association of Hospital Resources and Imaging Choice for Appendicitis in Pediatric Emergency Departments
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| Zeitschriftentitel: | Academic Emergency Medicine |
|---|---|
| Personen und Körperschaften: | , , , , , , , |
| In: | Academic Emergency Medicine, 24, 2017, 4, S. 400-409 |
| Format: | E-Article |
| Sprache: | Englisch |
| veröffentlicht: |
Wiley
|
| Schlagwörter: |
| author_facet |
Fullerton, Katherine Depinet, Holly Iyer, Sujit Hall, Matt Herr, Sandra Morton, Inge Lee, Timothy Melzer‐Lange, Marlene Fullerton, Katherine Depinet, Holly Iyer, Sujit Hall, Matt Herr, Sandra Morton, Inge Lee, Timothy Melzer‐Lange, Marlene |
|---|---|
| author |
Fullerton, Katherine Depinet, Holly Iyer, Sujit Hall, Matt Herr, Sandra Morton, Inge Lee, Timothy Melzer‐Lange, Marlene |
| spellingShingle |
Fullerton, Katherine Depinet, Holly Iyer, Sujit Hall, Matt Herr, Sandra Morton, Inge Lee, Timothy Melzer‐Lange, Marlene Academic Emergency Medicine Association of Hospital Resources and Imaging Choice for Appendicitis in Pediatric Emergency Departments Emergency Medicine General Medicine |
| author_sort |
fullerton, katherine |
| spelling |
Fullerton, Katherine Depinet, Holly Iyer, Sujit Hall, Matt Herr, Sandra Morton, Inge Lee, Timothy Melzer‐Lange, Marlene 1069-6563 1553-2712 Wiley Emergency Medicine General Medicine http://dx.doi.org/10.1111/acem.13156 <jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>Abdominal pain and concern for appendicitis are common chief complaints in patients presenting to the pediatric emergency department (<jats:styled-content style="fixed-case">PED</jats:styled-content>). Although many professional organizations recommend decreasing use of computed tomography (<jats:styled-content style="fixed-case">CT</jats:styled-content>) and choosing ultrasound as first‐line imaging for pediatric appendicitis, significant variability persists in imaging utilization. This study investigated practice variation across children's hospitals in the diagnostic imaging evaluation of appendicitis and determined hospital‐level characteristics associated with the likelihood of ultrasound as the first imaging modality.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This was a multicenter (seven children's hospitals) retrospective investigation. Data from chart review of 160 consecutive patients aged 3–18 years diagnosed with appendicitis from each site were compared with a survey of site medical directors regarding hospital resource availability, usual practices, and departmental‐level demographics.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In the diagnostic evaluation of 1,090 children with appendicitis, <jats:styled-content style="fixed-case">CT</jats:styled-content> scan was performed first for 22.4% of patients, with a range across <jats:styled-content style="fixed-case">PED</jats:styled-content>s of 3.1% to 83.8%. Ultrasound was performed for 54.0% of patients with a range of 2.5% to 96.9%. The only hospital‐level factor significantly associated with ultrasound as the first imaging modality was 24‐hour availability of in‐house ultrasound (odds ratio = 29.2, 95% confidence interval = 1.2–691.8).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Across children's hospitals, significant practice variation exists regarding diagnostic imaging in the evaluation of patients with appendicitis. Variation in hospital‐level resources may impact the diagnostic evaluation of patients with appendicitis. Availability of 24‐hour in‐house ultrasound significantly increases the likelihood of ultrasound as first imaging and decreases <jats:styled-content style="fixed-case">CT</jats:styled-content> scans. Hospitals aiming to increase the use of ultrasound should consider adding 24‐hour in‐house coverage.</jats:p></jats:sec> Association of Hospital Resources and Imaging Choice for Appendicitis in Pediatric Emergency Departments Academic Emergency Medicine |
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| title |
Association of Hospital Resources and Imaging Choice for Appendicitis in Pediatric Emergency Departments |
| title_unstemmed |
Association of Hospital Resources and Imaging Choice for Appendicitis in Pediatric Emergency Departments |
| title_full |
Association of Hospital Resources and Imaging Choice for Appendicitis in Pediatric Emergency Departments |
| title_fullStr |
Association of Hospital Resources and Imaging Choice for Appendicitis in Pediatric Emergency Departments |
| title_full_unstemmed |
Association of Hospital Resources and Imaging Choice for Appendicitis in Pediatric Emergency Departments |
| title_short |
Association of Hospital Resources and Imaging Choice for Appendicitis in Pediatric Emergency Departments |
| title_sort |
association of hospital resources and imaging choice for appendicitis in pediatric emergency departments |
| topic |
Emergency Medicine General Medicine |
| url |
http://dx.doi.org/10.1111/acem.13156 |
| publishDate |
2017 |
| physical |
400-409 |
| description |
<jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>Abdominal pain and concern for appendicitis are common chief complaints in patients presenting to the pediatric emergency department (<jats:styled-content style="fixed-case">PED</jats:styled-content>). Although many professional organizations recommend decreasing use of computed tomography (<jats:styled-content style="fixed-case">CT</jats:styled-content>) and choosing ultrasound as first‐line imaging for pediatric appendicitis, significant variability persists in imaging utilization. This study investigated practice variation across children's hospitals in the diagnostic imaging evaluation of appendicitis and determined hospital‐level characteristics associated with the likelihood of ultrasound as the first imaging modality.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This was a multicenter (seven children's hospitals) retrospective investigation. Data from chart review of 160 consecutive patients aged 3–18 years diagnosed with appendicitis from each site were compared with a survey of site medical directors regarding hospital resource availability, usual practices, and departmental‐level demographics.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In the diagnostic evaluation of 1,090 children with appendicitis, <jats:styled-content style="fixed-case">CT</jats:styled-content> scan was performed first for 22.4% of patients, with a range across <jats:styled-content style="fixed-case">PED</jats:styled-content>s of 3.1% to 83.8%. Ultrasound was performed for 54.0% of patients with a range of 2.5% to 96.9%. The only hospital‐level factor significantly associated with ultrasound as the first imaging modality was 24‐hour availability of in‐house ultrasound (odds ratio = 29.2, 95% confidence interval = 1.2–691.8).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Across children's hospitals, significant practice variation exists regarding diagnostic imaging in the evaluation of patients with appendicitis. Variation in hospital‐level resources may impact the diagnostic evaluation of patients with appendicitis. Availability of 24‐hour in‐house ultrasound significantly increases the likelihood of ultrasound as first imaging and decreases <jats:styled-content style="fixed-case">CT</jats:styled-content> scans. Hospitals aiming to increase the use of ultrasound should consider adding 24‐hour in‐house coverage.</jats:p></jats:sec> |
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| author | Fullerton, Katherine, Depinet, Holly, Iyer, Sujit, Hall, Matt, Herr, Sandra, Morton, Inge, Lee, Timothy, Melzer‐Lange, Marlene |
| author_facet | Fullerton, Katherine, Depinet, Holly, Iyer, Sujit, Hall, Matt, Herr, Sandra, Morton, Inge, Lee, Timothy, Melzer‐Lange, Marlene, Fullerton, Katherine, Depinet, Holly, Iyer, Sujit, Hall, Matt, Herr, Sandra, Morton, Inge, Lee, Timothy, Melzer‐Lange, Marlene |
| author_sort | fullerton, katherine |
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| description | <jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>Abdominal pain and concern for appendicitis are common chief complaints in patients presenting to the pediatric emergency department (<jats:styled-content style="fixed-case">PED</jats:styled-content>). Although many professional organizations recommend decreasing use of computed tomography (<jats:styled-content style="fixed-case">CT</jats:styled-content>) and choosing ultrasound as first‐line imaging for pediatric appendicitis, significant variability persists in imaging utilization. This study investigated practice variation across children's hospitals in the diagnostic imaging evaluation of appendicitis and determined hospital‐level characteristics associated with the likelihood of ultrasound as the first imaging modality.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This was a multicenter (seven children's hospitals) retrospective investigation. Data from chart review of 160 consecutive patients aged 3–18 years diagnosed with appendicitis from each site were compared with a survey of site medical directors regarding hospital resource availability, usual practices, and departmental‐level demographics.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In the diagnostic evaluation of 1,090 children with appendicitis, <jats:styled-content style="fixed-case">CT</jats:styled-content> scan was performed first for 22.4% of patients, with a range across <jats:styled-content style="fixed-case">PED</jats:styled-content>s of 3.1% to 83.8%. Ultrasound was performed for 54.0% of patients with a range of 2.5% to 96.9%. The only hospital‐level factor significantly associated with ultrasound as the first imaging modality was 24‐hour availability of in‐house ultrasound (odds ratio = 29.2, 95% confidence interval = 1.2–691.8).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Across children's hospitals, significant practice variation exists regarding diagnostic imaging in the evaluation of patients with appendicitis. Variation in hospital‐level resources may impact the diagnostic evaluation of patients with appendicitis. Availability of 24‐hour in‐house ultrasound significantly increases the likelihood of ultrasound as first imaging and decreases <jats:styled-content style="fixed-case">CT</jats:styled-content> scans. Hospitals aiming to increase the use of ultrasound should consider adding 24‐hour in‐house coverage.</jats:p></jats:sec> |
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| spelling | Fullerton, Katherine Depinet, Holly Iyer, Sujit Hall, Matt Herr, Sandra Morton, Inge Lee, Timothy Melzer‐Lange, Marlene 1069-6563 1553-2712 Wiley Emergency Medicine General Medicine http://dx.doi.org/10.1111/acem.13156 <jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>Abdominal pain and concern for appendicitis are common chief complaints in patients presenting to the pediatric emergency department (<jats:styled-content style="fixed-case">PED</jats:styled-content>). Although many professional organizations recommend decreasing use of computed tomography (<jats:styled-content style="fixed-case">CT</jats:styled-content>) and choosing ultrasound as first‐line imaging for pediatric appendicitis, significant variability persists in imaging utilization. This study investigated practice variation across children's hospitals in the diagnostic imaging evaluation of appendicitis and determined hospital‐level characteristics associated with the likelihood of ultrasound as the first imaging modality.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This was a multicenter (seven children's hospitals) retrospective investigation. Data from chart review of 160 consecutive patients aged 3–18 years diagnosed with appendicitis from each site were compared with a survey of site medical directors regarding hospital resource availability, usual practices, and departmental‐level demographics.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In the diagnostic evaluation of 1,090 children with appendicitis, <jats:styled-content style="fixed-case">CT</jats:styled-content> scan was performed first for 22.4% of patients, with a range across <jats:styled-content style="fixed-case">PED</jats:styled-content>s of 3.1% to 83.8%. Ultrasound was performed for 54.0% of patients with a range of 2.5% to 96.9%. The only hospital‐level factor significantly associated with ultrasound as the first imaging modality was 24‐hour availability of in‐house ultrasound (odds ratio = 29.2, 95% confidence interval = 1.2–691.8).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Across children's hospitals, significant practice variation exists regarding diagnostic imaging in the evaluation of patients with appendicitis. Variation in hospital‐level resources may impact the diagnostic evaluation of patients with appendicitis. Availability of 24‐hour in‐house ultrasound significantly increases the likelihood of ultrasound as first imaging and decreases <jats:styled-content style="fixed-case">CT</jats:styled-content> scans. Hospitals aiming to increase the use of ultrasound should consider adding 24‐hour in‐house coverage.</jats:p></jats:sec> Association of Hospital Resources and Imaging Choice for Appendicitis in Pediatric Emergency Departments Academic Emergency Medicine |
| spellingShingle | Fullerton, Katherine, Depinet, Holly, Iyer, Sujit, Hall, Matt, Herr, Sandra, Morton, Inge, Lee, Timothy, Melzer‐Lange, Marlene, Academic Emergency Medicine, Association of Hospital Resources and Imaging Choice for Appendicitis in Pediatric Emergency Departments, Emergency Medicine, General Medicine |
| title | Association of Hospital Resources and Imaging Choice for Appendicitis in Pediatric Emergency Departments |
| title_full | Association of Hospital Resources and Imaging Choice for Appendicitis in Pediatric Emergency Departments |
| title_fullStr | Association of Hospital Resources and Imaging Choice for Appendicitis in Pediatric Emergency Departments |
| title_full_unstemmed | Association of Hospital Resources and Imaging Choice for Appendicitis in Pediatric Emergency Departments |
| title_short | Association of Hospital Resources and Imaging Choice for Appendicitis in Pediatric Emergency Departments |
| title_sort | association of hospital resources and imaging choice for appendicitis in pediatric emergency departments |
| title_unstemmed | Association of Hospital Resources and Imaging Choice for Appendicitis in Pediatric Emergency Departments |
| topic | Emergency Medicine, General Medicine |
| url | http://dx.doi.org/10.1111/acem.13156 |