Robert Orth MD, PhD, Presenter: Grant, Toshiba Corporation Research support, General Electric Company

Sara Fallon, Abstract Co-Author: Nothing to Disclose

R. Paul Guillerman MD, Abstract Co-Author: Nothing to Disclose

Martha Mappus Munden MD, Abstract Co-Author: Nothing to Disclose

Wei Zhang PhD, Abstract Co-Author: Nothing to Disclose

George S. Bisset MD, Abstract Co-Author: Nothing to Disclose

Monica Lopez MD, Abstract Co-Author: Nothing to Disclose

Mary Brandt MD, Abstract Co-Author: Nothing to Disclose

To facilitate consistent, reliable communication among providers, we developed a novel scoring system for reporting limited right lower quadrant ultrasound (US) exams obtained for suspected pediatric appendicitis. The purpose of this study was to evaluate implementation of this scoring system and its ability to risk-stratify children with suspected appendicitis.

We developed a risk-stratification scale (Appy-Score) and structured reporting template for limited abdominal US exams obtained for suspected pediatric appendicitis. Appy-Score strata were: 1=normal completely visualized appendix; 2=normal partially visualized appendix; 3=non-visualized appendix, 4=equivocal; 5a=non-perforated appendicitis; 5b=perforated appendicitis. The Appy-Score was applied retrospectively to all limited right lower quadrant US exams ordered through our Emergency Department during a 5-month pre-implementation period (1/1/2013-5/31/2013), and Appy-Score use was tracked prospectively post-implementation (7/1/2013-9/30/2013). Diagnostic performance measures of US exams were computed post-implementation. Secondary outcomes included CT imaging following US exams and negative appendectomy rates.

We identified 1,235 patients in the pre- and 687 patients in the post-implementation groups. Appy-Score use increased from 24% in July to 89% in September (p=0.0001). The likelihood of appendicitis progressively increased with each score stratum. Sensitivity, specificity, positive predictive value and negative predictive value post-implementation were 93.8%, 92%, 83.8%, and 97.1%, respectively. The rate of CT imaging after US decreased from 8.6% pre-implementation to 5.9% post-implementation (p=0.048). Negative appendectomy rates did not significantly change (4.4% vs. 4.1%, p=0.88).

The use of a risk-stratified scoring system and standardized template for reporting the results of US exams for suspected pediatric appendicitis clearly communicated the likelihood of appendicitis to the treating physician and decreased the need for CT imaging. Future studies should assess whether this streamlines care in the emergency room setting and whether the risk strata are generalizable to other institutions with varying expertise in US imaging.

A scoring system for reporting limited US exams performed for suspected pediatric appendicitis can risk-stratify patients and decrease the rate of follow-up CT imaging.

Orth, R, Fallon, S, Guillerman, R, Munden, M, Zhang, W, Bisset, G, Lopez, M, Brandt, M, Development and Validation of an Ultrasound Scoring System for Children with Suspected Acute Appendicitis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14006891.html