Table 1.
Evaluation of pediatric appendicitis
| Study | Year | Findings | CHEERS Score (max 24) |
|---|---|---|---|
| Axelrod [18] | 2000 | US can be cost-saving as an adjunct to clinical decision making when deciding to observe or discharge benign pediatric abdominal pain; however, it is not cost-saving when appendicitis is strongly suspected | 14 |
| Pena [19] | 2000 | Staged imaging using US first followed by CT when US was negative or equivocal for pediatric appendicitis produced cost-savings compared to standard of care | 11 |
| Pershad [20] | 2015 | Using US and a clinical decision rule prior to CT for evaluation of pediatric appendicitis is more cost-effective than CT alone | 17 |
| Van Atta [21] | 2015 | Staged imaging with US first in pediatric patients with suspected appendicitis reduces overall cost through CT avoidance | 10 |
| Wagenaar [22] | 2015 | Staged imaging with US first in pediatric patients with suspected appendicitis reduces overall cost through CT avoidance and decreased length of stay | 8 |
| Gregory [23] | 2016 | The most cost-effective approach for assessing pediatric appendicitis is use of a clinical decision rule followed by staged imaging with US first | 22 |
| Anderson [24] | 2017 | A protocol using US and MRI for pediatric appendicitis successfully decreased use of CT scan though without any change in health outcomes and increased radiology costs over the study period | 13 |
| Imler [25] | 2017 | A comparison of US or MRI first in the evaluation of young patients for appendicitis showed higher overall costs and longer ED length of stay in the MRI group | 10 |
| Kharbanda [26] | 2018 | A study across nine pediatric EDs showed that in the evaluation of acute abdominal pain, US first sites had 5.2% lower total costs of treatment than CT first sites | 17 |
| Kobayashi [27] | 2018 | Implementation of an US first appendicitis pathway at a general hospital was unsuccessful in decreasing CT utilization due to poor adherence to the pathway | 8 |
| Nordin [28] | 2018 | Using a standardized reporting template to ensure US quality decreased equivocal studies and the need to perform CT scans for appendicitis in a pediatric ED, leading to further cost-savings estimated at nearly $150,000 per year | 11 |