Using portable ultrasound as a first-line imaging study in kids with suspected appendicitis helps reduce emergency room length of stay and reduces the need for CT scans, according to a recent study (Elikashvili et al. The Effect of Point-of-care Ultrasonography on Emergency Department Length of Stay and Computed Tomography Utilization in Children With Suspected Appendicitis. Acad Emerg Med. 2014;21:163)
In the study, investigators looked at the records of 150 children seen consecutively between May 1, 2011 and October 1, 2012 in an urban pediatric emergency department. All children were under evaluation for suspected appendicitis. Outcomes were determined by surgical or pathology report in those found to have appendicitis and three weeks later in patients who were deemed not to have appendicitis. The time to perform the point-of-care ultrasound and CT scan use was measured.
“CT scans have been the best imaging test for diagnosing appendicitis, but they expose children to radiation, which cumulatively can prove harmful” said the study’s senior author, Dr J W Tsung
“CT scanning rate was reduced by over 35% during the study,” commented Dr Ee Tay, the study’s second author.
The study showed that emergency department length of stay declined by 2 hrs and 14 minutes (46% decrease) for those requiring radiology department ultrasound and nearly 6 hours (68% decrease) for those requiring CT scan when point-of-care ultrasound was inconclusive as a first-line imaging study. Importantly, no cases of appendicitis were missed with the point-of-care ultrasound protocol and no unnecessary surgeries were performed for a normal appendix.