AAP News: Predicting Appendicitis. Making a Cutting-Edge Decision with the Most Cost-Effective Diagnostic Strategies

By Lewis First, MD, MS

All of us who practice pediatrics have come across patients with acute abdominal signs and symptoms that raise the possibility of appendicitis. Yet once we are concerned, how we move forward to confirm or rule-out the diagnosis can take many pathways based on risk and availability of services (e.g, going directly to the operating room; imaging with CT, MRI, or ultrasound). These approaches can be combined into many permutations. 

The results of this study demonstrate that the most cost-effective strategy for those at moderate risk for appendicitis is to obtain an ultrasound and follow it with a CT scan if the appendix cannot be visualized by the ultrasound or if secondary signs of appendicitis are seen. The authors also note that if the chance of appendicitis is less than 16% or over 95%, then no imaging would be most cost-effective. The authors suggest that this kind of analysis can lead to a personalized approach to care that can improve outcomes and decrease cost.

Drs. Rebecca Rentea and Charles Snyder reiterate the solid methodology used to look at cost-effectiveness in this study, but also raise some limitations for us to consider before we implement the algorithmic approach of Drs. Jennings et al. For example, they note hidden costs, the quality of the person doing  the ultrasound, and other diagnostic strategies not considered in the study. 

Read the full story via AAP News

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