IMPACT OF CLINICAL PRACTICE GUIDELINES ON COMPUTED TOMOGRAPHY USE FOR SUSPECTED APPENDICITIS: A PROSPECTIVE AUDIT STUDY.

Dr. Amit Kumar Gupta; Sarfaraz Nawaz; Aditya Anand; Mohtamim Haider

doi:10.51168/sjhrafrica.v5i3.1137

Authors

Dr. Amit Kumar Gupta Assistant Professor, Department of General Surgery, Mata Gujri Memorial Medical College & Lion Seva Kendra, Kishanganj, Bihar, India
Dr. Md. Sarfaraz Nawaz Assistant Professor, Department of General Surgery, Mata Gujri Memorial Medical College & Lion Seva Kendra, Kishanganj, Bihar, India.
Dr. Aditya Anand Assistant Professor, Department of General Surgery, Mata Gujri Memorial Medical College & Lion Seva Kendra, Kishanganj, Bihar, India.
Dr. Md. Mohtamim Haider Professor & HOD, Department of General Surgery, Mata Gujri Memorial Medical College & Lion Seva Kendra, Kishanganj, Bihar, India.

DOI:

https://doi.org/10.51168/sjhrafrica.v5i3.1137

Keywords:

Appendicitis, Abdominal pain, Diagnostic testing, Clinical decision rule

Abstract

Background.

The Royal Adelaide Hospital implemented a clinical practice guideline for the treatment of patients with suspected appendicitis. This recommendation suggests using CT scanning sparingly until more research is done. This study compared the CT usage rate for the patients during the pre-and post-guideline implementation periods.

Methods.

The prospective audit study included patients who came to the emergency room with symptoms and physical results that suggested they might have appendicitis. During the period following the implementation of the guidelines, these individuals were also prospectively identified if they were referred to the on-call surgical registrar. They were identified via hospital and emergency department databases.

Results.

The study included 119 individuals, 88 of whom underwent appendectomies for appendicitis. Following new clinical practice guidelines from the hospital that advised limited use of CT scans—specifically for patients over 50 or obese after a 24-hour observation—CT scan usage decreased from a baseline of 33% to 9%, reflecting a 31% overall reduction and a 24% decrease in unnecessary procedures. Significant reductions were observed in two patient groups: Group 2 (from 6 to 4 CT scans, p = 0.0331) and Group 3 (from 11 to 7, p = 0.0088), demonstrating the guidelines' effectiveness despite some limitations in statistical power.

Conclusion.

According to this study, hospitals with high rates of CT use for suspected appendicitis should lower these rates to match the national norm. Clinical practice standards or protocols may help with this effort.

Recommendation.

This study recommends that hospitals with high CT scan usage for suspected appendicitis adopt restrictive CT guidelines similar to those at the Royal Adelaide Hospital, focusing on limited use based on clinical inconclusiveness or specific risk factors like obesity or age over 50.