Magnetic Resonance Imaging Versus Ultrasound as the Initial Imaging Modality for Pediatric and Young Adult Patients With Suspected Appendicitis

Imler, Daniel; Keller, Christine; Sivasankar, Shyam; Wang, Nancy Ewen; Vasanawala, Shreyas S.; Bruzoni, Matías; Quinn, James V.

doi:10.1111/acem.13180

Cited by 44 publications

(13 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We identified 11 studies that assessed the cost-effectiveness of US in the evaluation of acute appendicitis [18][19][20][21][22][23][24][25][26][27][28]. The impetus to avoid radiation in the pediatric population has sparked substantial research interest in this area.…”

Section: Evaluation Of Pediatric Appendicitismentioning

confidence: 99%

“…Imler [25] 2017 A comparison of US or MRI first in the evaluation of young patients for appendicitis showed higher overall costs and longer ED length of stay in the MRI group 10 Kharbanda [26] 2018 A study across nine pediatric EDs showed that in the evaluation of acute abdominal pain, US first sites had 5.2% lower total costs of treatment than CT first sites 17…”

mentioning

confidence: 99%

See 1 more Smart Citation

A systematic review of the cost-effectiveness of ultrasound in emergency care settings

et al. 2021

View full text Add to dashboard Cite

Background The use of ultrasound (US) in emergency departments (ED) has become widespread. This includes both traditional US scans performed by radiology departments as well as point-of-care US (POCUS) performed by bedside clinicians. There has been significant interest in better understanding the appropriate use of imaging and where opportunities to enhance cost-effectiveness may exist. The purpose of this systematic review is to identify published evidence surrounding the cost-effectiveness of US in the ED and to grade the quality of that evidence. Methods We performed a systematic review of the literature following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Studies were considered for inclusion if they were: (1) economic evaluations, (2) studied the clinical use of ultrasound, and (3) took place in an emergency care setting. Included studies were critically appraised using the Consolidated Health Economic Evaluation Reporting Standards checklist. Results We identified 631 potentially relevant articles. Of these, 35 studies met all inclusion criteria and were eligible for data abstraction. In general, studies were supportive of the use of US. In particular, 11 studies formed a strong consensus that US enhanced cost-effectiveness in the investigation of pediatric appendicitis and 6 studies supported enhancements in the evaluation of abdominal trauma. Across the studies, weaknesses in methodology and reporting were common, such as lack of sensitivity analyses and inconsistent reporting of incremental cost-effectiveness ratios. Conclusions The body of existing evidence, though limited, generally demonstrates that the inclusion of US in emergency care settings allows for more cost-effective care. The most definitive evidence for improvements in cost-effectiveness surround the evaluation of pediatric appendicitis, followed by the evaluation of abdominal trauma. POCUS outside of trauma has had mixed results.

show abstract

Section: Evaluation Of Pediatric Appendicitismentioning

confidence: 99%

mentioning

confidence: 99%

A systematic review of the cost-effectiveness of ultrasound in emergency care settings

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Medical imaging plays an important role in patients who present with an atypical clinical presentation or a relatively low clinical probability of appendicitis. International differences exist in diagnostic imaging pathways for suspected appendicitis, with computed tomography (CT), ultrasound, and more recently, magnetic resonance imaging shown to be of use [3]. It is widely accepted that, in children, ultrasound should be the first-line imaging modality, as it avoids the radiation burden of CT [4].…”

Section: Introductionmentioning

confidence: 99%

Improving the value of ultrasound in children with suspected appendicitis: a prospective study integrating secondary sonographic signs

et al. 2019

View full text Add to dashboard Cite

show abstract

“…28 MRI has the obvious benefit of avoiding radiation exposure, but the disadvantages of higher cost, less availability than CT and also MRI may not be tolerated in young children (especially under age 5). 29 Although, Feed and swaddle MRI is feasible without sedation up to 6 months of age. 30 Anecdotally, MRI usage has increased in the emergency setting in recent years, perhaps due to radiation concerns raised in campaigns such as "Image Gently" 31 and "As Low As Reasonably Achievable (ALARA)", 32 and perhaps with increase in the availability of the modality, but to date, only three single centre studies describing MRI utilization in paediatric EDs [33][34][35] have been published, and further evidence-based research is needed.…”

mentioning

confidence: 99%

Overuse of CT and MRI in paediatric emergency departments

Ohana

Soffer

Zimlichman

et al. 2018

The British Journal of Radiology

View full text Add to dashboard Cite

The aim of this review is to survey CT and MRI overuse in the paediatric emergency department (ED) population. CT is one of the most important modalities employed in the ED. Not surprisingly, its high accuracy, rapid acquisition and availability have resulted in overuse. An obvious limitation of CT is ionizing radiation; in addition there are economic implications to overuse. Studies from the last two decades have shown increase in paediatric ED CT utilization in the first decade, reaching a plateau forming around 2008, followed by a decrease in the last decade. This decrease occurred in conjunction with campaigns raising awareness to the risks of radiation exposure. Although a trend of decrease in overuse have been observed, great variability has been shown across different facilities, as well as among physicians, with more pronounced overuse in non-teaching and non-children dedicated EDs. The leading types of paediatric ED CTs are head and abdominal scans. Decision rules, such as PECARN for head injury and the Alvarado score for abdominal pain, as well as using alternative imaging modalities, have been shown to reduce CT overuse in these two categories. MRI has the obvious benefit of avoiding radiation exposure, but the disadvantages of higher costs, less availability and less tolerability in younger children. Although anecdotally paediatric ED MRI usage has increased in recent years, only scarce reports have been published. In our opinion, there is need to conduct up-to-date studies covering paediatric CT and MRI overuse trends, usage variability and adherence to clinical protocols.

show abstract

Magnetic Resonance Imaging Versus Ultrasound as the Initial Imaging Modality for Pediatric and Young Adult Patients With Suspected Appendicitis

Cited by 44 publications

References 41 publications

A systematic review of the cost-effectiveness of ultrasound in emergency care settings

A systematic review of the cost-effectiveness of ultrasound in emergency care settings

Improving the value of ultrasound in children with suspected appendicitis: a prospective study integrating secondary sonographic signs

Overuse of CT and MRI in paediatric emergency departments

Contact Info

Product

Resources

About