Children evaluated in the emergency department for possible appendicitis are often admitted for observation, despite the widespread availability of accurate diagnostic studies, particularly computed tomography (CT).
We sought to establish effective and efficient strategies for using CT to diagnose and manage children with possible appendicitis.
Retrospective chart review and decision analysis.
Emergency department of a large, urban tertiary care pediatric teaching hospital.
All patients admitted from January 1996 to August 1997 for suspected appendicitis.
Three modeled strategies were empirically applied to the retrospective cohort of patients admitted for observation.
Outcomes and costs under the modeled strategies were compared with those under current practice.
The three strategies were : 1) to obtain CT scans on all patients and discharge those with normal findings ; 2) to obtain CT scans and admit all patients ; 3) to selectively obtain CT scans on those patients with a peripheral white blood cell count>10 000/mm3 (10 x 109/L) and admit all.
The sensitivity and specificity of CT for diagnosing appendicitis were determined empirically from the data.
A sensitivity analysis was performed.
The number of preoperative inpatient observation days, total hospital costs, and the rates of both missed appendicitis and negative laparotomies.
Mots-clés Pascal : Appendicite, Tomographie, Economie santé, Diagnostic, Analyse coût, Pronostic, Enfant, Homme, Appareil digestif pathologie, Intestin pathologie, Radiodiagnostic
Mots-clés Pascal anglais : Appendicitis, Tomography, Health economy, Diagnosis, Cost analysis, Prognosis, Child, Human, Digestive diseases, Intestinal disease, Radiodiagnosis
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0495849
Code Inist : 002B13B03. Création : 22/03/2000.