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Table 1 Evaluation of pediatric appendicitis

From: A systematic review of the cost-effectiveness of ultrasound in emergency care settings

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