The use of clinical decision support to reduce inappropriate CT imaging for paediatric appendicitis: A structure literature review

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Saudi Digital Library
Abstract Aim: To investigate the efficiency of clinical decision support (CDS) system to diagnose acute appendicitis in paediatric patients. Also, to explore its efficiency to reduce the use of CT scans for appendicitis diagnosis in that population. Background: Acute appendicitis is one of the most common reasons for paediatric emergency abdominal surgical procedures. 40% of appendicitis cases in children are misdiagnosed. This misdiagnosis leads to delay in diagnosis which leads to increased morbidity and mortality. CT scan is common modality that is used in the diagnosis of appendicitis in paediatric patients however it associated with high dose of radiation that may lead to cancer. There is no decrease in the rate of appendicitis complications, such as perforation, with the increased use of CT scans. In addition, the overuse of CT scan has become an issue since CT increases radiation exposure. CDS is a program designed to provide information that help clinicians to make decisions in a medical environment. CDS has been used as an innovative automated prediction tool to deliver diagnostic information for paediatric patient with suspected appendicitis in the emergency departments Methods: A systematic literature review was undertaken with the help of the question following PICO structure, where the journals for inclusion in the study were searched online through database research. The databases that were searched included Medline, CINAHL and Cochrane library since they are able to produce optimal combinations and source more than 95% of studies that were suitable for the search. Exclusion and inclusion criteria were therefore used to select the journals that were included in the analysis. The Critical Appraisal Skills Programme (CASP) tool was used to critical appraisal the included studies. Results: Five studies that were relevant to research question were included in this research. A total of 11205 paediatric participants with suspected appendicitis were investigated. Included studies showed that CDS is effective in acute appendicitis diagnosis for paediatric patients with suspected appendicitis. Three studies showed that CDS was associated with reduced CT scans, and they reported statistically significant results. Two studies reported that using CDS did not lead to decrease in CT scans use. Conclusion: CDS is an important tool that benefits acute appendicitis diagnosis and is associated with a reduction in CT scans usage therefore lowering the dose to paediatric patients. It is recommended to implement CDS as acute appendicitis diagnosis modality.