Approaching zero: Implications of a computed tomography reduction program for pediatric appendicitis evaluation

Purpose Because of awareness of iatrogenic radiation exposure, there is a national trend of diminishing computed tomography (CT) use for pediatric suspected appendicitis. The purpose of this study was to evaluate the effects of a CT reduction program for evaluation of appendicitis. Methods A multidisciplinary group (emergency medicine, radiology, and surgery) at a children's hospital developed a reduction program which included: ultrasound (U/S) first (2012), magnetic resonance imaging (MRI) second (2014), and standardized U/S reports (2016). Imaging modality, negative appendectomy rate, time from first image to incision, and imaging costs were evaluated over time. Results Of the 571 patients evaluated from 2012 to 2016, there was a significant decrease in CT use and increase U/S and MRI use over the study period (all p < 0.01). CT use approached zero in 2016. Time from first image to incision (median 10.7 h, IQR 5.6–15.5) and negative appendectomy rate (mean 3.7 ± 0.2%) did not change. Median imaging costs ($88, IQR $52–$169) and radiology percent of total costs (range 0.8%–3.9%) increased over time (both p < 0.01). Conclusion Approaching zero CT use for evaluation of pediatric appendicitis is possible through a multidisciplinary protocol without impacting clinical outcomes. However, increased MRI use led to higher costs. Cost-effectiveness of replacing CT with MRI warrants further study. Type of study Retrospective comparative study. Level of evidence Level III.