Clinical Decision Support Tool Cuts CT Use for Appendicitis

Multicomponent electronic clinical decision tool reduces CT use in children with possible appendicitis


WEDNESDAY, April 13, 2016 (HealthDay News) -- The implementation of a multicomponent electronic clinical decision support tool reduces computed tomography (CT) use for pediatric patients with possible appendicitis, according to a study published online April 13 in Pediatrics.

Anupam B. Kharbanda, M.D., from the Children's Hospitals and Clinics of Minnesota in Minneapolis, and colleagues conducted a quasi-experimental study involving children aged 3 to 18 years who presented with possible appendicitis to the pediatric emergency department. The authors examined the use of CT and ultrasound (US) from January 2011 to December 2013.

The researchers found that 28 percent of the 2,803 patients with acute abdominal pain over the three-year study period had appendicitis, and 26.1 percent of those with appendicitis had a perforation. During the 10-month preimplementation period, CT use was 38.8 percent, and decreased to 17.7 percent by the end of the study. From the preimplementation period to implementation there was a significant change in trend (monthly decrease, −3.5 percent; P = 0.007). Use of US was 45.7 percent and 59.7 percent during preimplementation and implementation, respectively. US and total imaging trends did not change significantly. The rates of missed appendicitis, emergency department revisits within 30 days, appendiceal perforation, and emergency department length of stay did not differ significantly between time periods.

"Our electronic clinical decision support tool was associated with a decrease in CT use while maintaining safety and high quality care for patients with possible appendicitis," the authors write.

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