A. Nordin1, S. Sales1, J. Nielsen1, B. Adler2,3, D. Bates2,3, B. Kenney1,3 1Nationwide Children’s Hospital,Department Of Surgery,Columbus, OH, USA 2Nationwide Children’s Hospital,Department Of Radiology,Columbus, OH, USA 3The Ohio State University College Of Medicine,Columbus, OH, USA
Introduction:
Appendicitis is the most common abdominal surgical emergency in children, and imaging is an important diagnostic adjunct. While computed tomography (CT) scans are commonly used in adults, ultrasound is preferred in children to minimize radiation exposure. Furthermore, CT scans are more expensive than ultrasound. We have previously reported our experience in instituting a standardized ultrasound report for appendicitis, which decreased our CT rate by 67.3%. In this analysis, we seek to demonstrate the cost savings associated with using this ultrasound template.
Methods:
Retrospective chart review for the three month period immediately preceding template implementation (6/2012 to 9/2012) was combined with prospective review through the end of 12/2015 for all patients presenting to the emergency department who received diagnostic imaging for suspected appendicitis. The type of imaging and its results were recorded and percent compliance to the template, sensitivity and specificity, and CT rates were calculated. Cost information was obtained from the 2016 Ohio Medicaid Fee Schedule. Total estimated annual imaging costs using pre-template ultrasound and CT utilization rates were compared with post-template annual costs to calculate both the annual and cumulative savings of this new imaging strategy.
Results:
In our pre-template period, 304 ultrasounds and 168 CTs were performed for utilization rates of 80.2% and 44.3% respectively. Extrapolating these numbers over a year results in 1132 ultrasounds and 626 CTs, with a combined annual cost of $300,527.70. Similar calculations were performed for each succeeding year, in order to account for changes in patient volume (Figure 1). By the end of 2015, 1733 ultrasounds and 156 CTs were performed; the rate of ultrasound usage increased to 98.9% while the CT rate declined to 8.9%. At these rates, our total annual cost was $223,043.71, a savings of $149,458.86 from the estimated cost of $372,502.57 using pre-template imaging rates. Since implementation, annual savings have steadily increased for a projected cumulative cost savings of $339,273.74.
Conclusion:
Standardizing ultrasound reports for appendicitis not only reduces the rate of CT scans and the resultant radiation exposure but also decreases annual imaging costs, even in spite of increased numbers of patients evaluated for appendicitis. This change in imaging strategy has been maintained over several years. Continued cost reduction may be possible through the use of diagnostic algorithms to further decrease the number of imaging studies.
