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The optimal initial management of children with suspected appendicitis: a decision analysis
Journal article   Peer reviewed

The optimal initial management of children with suspected appendicitis: a decision analysis

Benjamin A. Hagendorf, John R. Clarke and Randall S. Burd
Journal of pediatric surgery, v 39(6), pp 880-885
2004
DOI: https://doi.org/10.1016/j.jpedsurg.2004.02.036
PMID: 15185218
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Appendicitis computed tomography cost-effectiveness analysis decision analysis hospital charges length of stay ultrasonography
As abdominal imaging has improved, the use of computed tomography (CT) and ultrasonography (US) for evaluating children with suspected appendicitis has increased. The purpose of this study was to determine the optimal management strategy for evaluating children with suspected appendicitis given the current accuracy of abdominal imaging. Decision analysis was used to evaluate 5 management strategies: discharge, observation, CT, US, and appendectomy. Probabilities and time variables were obtained from publications and a chart review. Each approach was evaluated for its impact on length of stay, hospital charges, cost effectiveness and its capacity to minimize perforation and avoid negative appendectomy (risk-benefit). Discharge was preferred when the probability of appendicitis was low (<0.09 to <0.47), imaging when in an intermediate range and surgery when high (>0.61 to >0.91). A role for observation was found only when the anticipated time of inpatient observation was brief (<9 hours). Although CT was more expensive than US, CT was more cost effective for preventing negative appendectomy and perforation and achieved a better risk-benefit. CT has an important role in the management of suspected appendicitis. Among children with a low or high likelihood of appendicitis, the cost of imaging tests required to prevent the complications of appendicitis is high.

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27 citations in Web of Science
36 citations in Scopus

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#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Pediatrics
Surgery
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