Introduction: Appendicitis is the most common emergency surgical disease in children. Those with perforated appendicitis have a more complicated and varied course. Through a clinical practice guideline (CPG), we sought to reduce computed tomography scans, laboratory draws, and exposure to broad-spectrum antibiotics without adversely affecting length of stay, hospital readmission, or repeat antibiotic administration.
Methods: Electronic records were retrospectively reviewed before and after CPG implementation, and data was collected in REDCap.
Results were reported as mean or percent incidence, and statistical analysis was done using a Student’s t-test, Mann-Whitney U test, or Pearson’s χ2 with P < .05 considered significant. Results: One hundred patients with a perforated appendix (50 before and 50 after CPG implementation) were included in our analysis. Length of stay (4.98 vs 4.46 days; P = .25), hospital readmission rate (10% vs 14%; P = .54), and additional antibiotic administration (2% vs 4%; P = .56) did not change. We observed no difference in the Pediatric Appendicitis Score (9 vs 9; P = .48) and a trending increase in evaluation at an outside hospital (56% vs 74%; P = .06). Rates of computed tomography scans did not differ overall (50% vs 40%; P = .31), but showed a decreasing trend at our institution (30% vs 12%; P = .06). We also found fewer post-operative laboratory studies (90% vs 38%; P < .01) and patients who received broad-spectrum intravenous antibiotics (92% vs 18%; P < .01).
Discussion: Through implementing the CPG we were able to understand our practice patterns and identify opportunities for improvement. Patients with perforated appendicitis were selected for study because they were affected by all components of the CPG and allowed for total adherence to be our primary outcome. Total adherence was set as the primary outcome knowing it would be difficult to achieve, but would also better identify opportunity for improvement and provide comprehensive assessment of the guideline.
Conclusions: Implementing a multidisciplinary CPG reduced health care use and improved antimicrobial stewardship without increasing complications in pediatric acute appendicitis.
Vernamonti, Jack; Robin Cotter; Jubulis, Jennifer; and Pandya, Kartikey
"Implementing a Clinical Practice Guideline for Pediatric Appendicitis Safely Reduced Health Care Use and Improved Antimicrobial Stewardship,"
Journal of Maine Medical Center: Vol. 3
, Article 7.
Available at: https://doi.org/10.46804/2641-2225.1089