Costs and effectiveness of ultrasonography and limited computed tomographyfor diagnosing appendicitis in children

Background. A protocol of ultrasonography (US) followed by computed tomogra phy with rectal contrast (CTRC) has been shown to be 94% accurate in the di agnosis of acute appendicitis in children. Objective. To evaluate the changes in patient management and costs of a pro tocol using US and CTRC in the evaluation of appendicitis in children. Design, Setting, and Subjects. Prospective cohort study of 139 children bet ween 3 and 21 years of age who had equivocal clinical findings for acute ap pendicitis seen in the emergency department of a large, urban pediatric tea ching hospital between July 1998 and December 1998. Protocol. Children with equivocal clinical presentations for acute appendic itis were prospectively evaluated with US. Patients with positive findings for acute appendicitis went directly to the operating room. Patients with n egative or equivocal findings on US underwent CTRC. Surgical management pla ns were recorded before imaging, after US, and after CTRC. Main Outcome Measures. Surgical management plans before and after the imagi ng protocol as well as total hospital direct and indirect costs incurred or saved by each change in management were determined. Costs were obtained th rough the hospital's cost database and by ratios of costs to charges. Results. Of the 139 children, the protocol resulted in a beneficial change in management in 86 children (61.9%), no change in management in 50 childre n (36.0%) and an incorrect change in management in 3 children (2.1%). US al one resulted in a beneficial change in management decision in 12/31 childre n (38.7%), while US followed by CTRC resulted in a beneficial change in man agement in 74/108 children (68.5%). The protocol resulted in a total cost s avings of $78 503.99 or $565/patient. Conclusion. A protocol of US followed by CTRC in children with negative or equivocal US examinations results in a high rate of beneficial change in ma nagement as well as in total cost savings in children with equivocal clinic al presentations for suspected appendicitis.