The Introduction of a Clinical Practice Guideline for the Management of Suspected Appendicitis May Influence Computed Tomography Usage

Background: A clinical practice guideline for the management of patients with suspected appendicitis was introduced at the Royal Adelaide Hospital. This guideline advises on restricted use of CT scanning for further investigation. The aim of this study was to compare pre and post guideline implementation periods for CT usage rate on such patients. Method: Patients that presented to the Emergency Department and had symptoms and exam findings suspicious for appendicitis were included in the study. Such patients were identified from hospital and emergency department databases and in the post guideline implementation period were also identified prospectively if they were referred to the on-call surgical registrar. Results: Two hundred and sixty-five patients were included in the study with 88 patients having had appendicectomies for appendicitis. Analysis was compared in 4 patients groups. CT usage was less in the post guideline implementation by a total of 31%. In 2 of the groups the result was statistically significant. There was no significant change in unnecessary operations (24%) following implementation of the guideline although statistical power was weak for this analysis. Conclusion: This study suggests that hospitals with high CT usage rates for suspected appendicitis can reduce their CT usage to be consistent with the national average and clinical practice guidelines or protocols may assist in this endeavor

Author(s): Damien Harris and Cea-Cea Moller

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