Effects on medical care by making a clinical pathway for childhood acute appendicitis

Abstract

　Acute appendicitis is the most common condition behind acute abdomen for children. Perforation cases due to diagnostic delay or negative appendectomy by uncertain diagnosis remain a serious issue. We made a clinical pathway in 2001 and developed a diagnostic score in 2005 for acute appendicitis among children. In order to clarify the effect of the clinical pathway and the diagnostic score, we divided 183 children, ≦15 years old, who underwent appendectomy between 1998 and 2008 into three periods（1st period; Pre-path, 2nd period; Post-path, 3rd period; Post-score）. When the 2nd period was compared with the 1st period, postoperative complications decreased to 2.9％ from 22.8％（to 0％ from 8.5％ in non-perforation cases, and to 20％ from 90％ in perforation cases）. Average postoperative hospitalization was significantly shortened from 8.5±4.2 days to 3.4 ± 4.0 days. Furthermore, the negative appendectomy rate also decreased to 5.7％ in the 3rd period by using the appendicitis diagnostic score. In order to make a clinical pathway, it is necessary to review the past cases and to build scientific evidence in each procedure of treatment. Many problems and solutions will be clarified in those processes. We must continuously revise the clinical pathway by repeating hypothesis and verification.