Standardized ultrasound templates for diagnosing appendicitis reduce annual imaging costs

• Published in: The Journal of surgical research 2018-01, Vol.221, p.77-83
• Main Authors: Nordin, Andrew B., Sales, Stephen, Nielsen, Jason W., Adler, Brent, Bates, David Gregory, Kenney, Brian
• Format: Article
• Language: English
• Subjects: Appendicitis; Appendicitis - diagnostic imaging; Appendicitis - economics; Child; Computed tomography; Cost analysis; Humans; Retrospective Studies; Tomography, X-Ray Computed - economics; Tomography, X-Ray Computed - statistics & numerical data; Ultrasonography - economics; Ultrasonography - standards; Ultrasonography - statistics & numerical data; Ultrasound
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2017.07.002

Ultrasound is preferred over computed tomography (CT) for diagnosing appendicitis in children to avoid undue radiation exposure. We previously reported our experience in instituting a standardized appendicitis ultrasound template, which decreased CT rates by 67.3%. In this analysis, we demonstrate the ongoing cost savings associated with using this template. Retrospective chart review for the time period preceding template implementation (June 2012-September 2012) was combined with prospective review through December 2015 for all patients in the emergency department receiving diagnostic imaging for appendicitis. The type of imaging was recorded, and imaging rates and ultrasound test statistics were calculated. Estimated annual imaging costs based on pretemplate ultrasound and CT utilization rates were compared with post-template annual costs to calculate annual and cumulative savings. In the pretemplate period, ultrasound and CT rates were 80.2% and 44.3%, respectively, resulting in a combined annual cost of $300,527.70. Similar calculations were performed for each succeeding year, accounting for changes in patient volume. Using pretemplate rates, our projected 2015 imaging cost was $371,402.86; however, our ultrasound rate had increased to 98.3%, whereas the CT rate declined to 9.6%, yielding an annual estimated cost of $224,853.00 and a savings of $146,549.86. Since implementation, annual savings have steadily increased for a cumulative cost savings of $336,683.83. Standardizing ultrasound reports for appendicitis not only reduces the use of CT scans and the associated radiation exposure but also decreases annual imaging costs despite increased numbers of imaging studies. Continued cost reduction may be possible by using diagnostic algorithms.