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Journal of General and Emergency Medicine

JGEM

Aabstract

Research Article

Decline in Abdominal CT Utilization Rates for Emergency Department Diagnosis of Appendicitis after Implementation of a Focused MRI Protocol

Solomon Behar, Y. Liza Kearl, Carl Berdahl, Emily Rose, Madhu Hardasmalani, Genevieve Santillanes, Ryan Raam, Igor Kagen and Ilene Claudius

Correspondence Address :

Emily Rose
Department of Pediatrics and Emergency Medicine1 USC
Keck School of Medicine
USA
Email: Emilyrose010@gmail.com

Received on: December 09, 2016;, Accepted on: December 27, 2016, Published on: January 03, 2017

Citation: Solomon Behar, Y. Liza Kearl, Carl Berdahl, et al. (2017) Decline in Abdominal CT Utilization Rates for Emergency Department Diagnosis of Appendicitis after Implementation of a Focused MRI Protocol

Copyright: 2017 Emily Rose, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

  • Abstract

Abstract
Background:
Ultrasound (US) and computed tomography (CT) have been the primary imaging tools used to confirm or exclude the diagnosis of appendicitis; however, use of US can be complicated by non-diagnostic studies. Magnetic resonance imaging (MRI) is sensitive and specific for the diagnosis of appendicitis in children.
Objective: To assess whether a decrease in ED CT utilization rates to evaluate for appendicitis would be achieved with the implementation of a MRI protocol. 
Materials and Methods:
We retrospectively compared rates of ED CT utilization for pediatric patients aged 3-21 years with suspected appendicitis over an 18-month period prior to adoption of ubiquitously available dedicated appendiceal MRI protocol (7/2008-12/2009) with those from an 18-month period following adoption of the protocol (7/2012-12/2013). Frequency of abdominal CTs done for the evaluation of appendicitis in the early and late time periods were compared via Chi-squared test. 
Results: 
In the early period, 94/175 (53.7%) of abdominal CT were done to rule out appendicitis. In the late period, 55/147 (37.4%) of abdominal CTs were done to rule out appendicitis. X2 test showed a significant decrease between early and late abdominal CT usage to evaluate appendicitis (p= 0.005). Abdominal CTs ordered for indications other than ruling out appendicitis increased by 13.6% during the same time period.
Conclusion: Availability of an MRI protocol to diagnose appendicitis decreased use of abdominal CT scans, thereby decreasing radiation exposure in children with abdominal pain concerning for appendicitis in an ED setting. 

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