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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