Large Pediatric Teaching Hospital Research Articles

Development of an Institution-Wide Pediatric End-of-Life Summit.

End-of-life (EOL) care in pediatrics is a unique subspecialty lacking adequate provider education and training. Patient and family outcomes may improve when clinicians are provided with training in this care. Recognizing the need for this specialized education, a small group of bereavement coordinators created an institution-wide pediatric EOL summit at a large urban pediatric teaching hospital. One hundred forty-five clinicians from 14 diverse disciplines attended the first annual pediatric EOL summit. A survey was sent to the participants for feedback. The survey results suggested an overwhelmingly positive response to the summit. Continuing to provide this educational conference is critical to improving care for patients and families, particularly at the end of life.

Implementation of After-Hours Nurse Line in an Academic Pediatric Endocrinology Practice

Background. After-hours triage of pediatric patients by trained nurses improves consistency of triage decisions, access, and quality of care, and decreases burden on physicians on-call. There is a lack of published experience with this approach in the pediatric diabetes population. Methods. An after-hours call service was established in September 2019 in our large urban pediatric teaching hospital. Barton Schmitt guidelines, which are widely accepted as the standard for telephone triage care, were modified to include institution specific diabetes management protocols. We analyzed demographics, reasons for call, clinical presentation to the emergency room, and clinical disposition of the callers. Results. The after-hours call service handled 70% of calls without physician involvement. There were no patients triaged to home care who subsequently required an emergency room visit or hospitalization. Patients who called the after-hours nurse line prior to coming to the emergency room were less sick and were discharged more often from the emergency room. Spanish-speaking parents utilized the service less than English speakers. There were no disparities in utilization based on the insurance status or race. Conclusions. The after-hours service accurately triaged calls and reduced physician burden. Patients of all races and insurance statuses utilized the after-hours service equally well. Language was a barrier in the utilization.

Virtual Clinics for Diabetes Care.

Virtual Clinics for Diabetes Care.

Impact of the COVID-19 pandemic on management of children and adolescents with Type 1 diabetes

BackgroundThe coronavirus disease-2019 (COVID-19) pandemic had widespread impacts on the lives of parents and children. We determined how the pandemic affected Type 1 diabetes patients at a large urban pediatric teaching hospital.MethodsWe compared patient characteristics, glycemic control, PHQ-9 depression screen, in person and virtual outpatient encounters, hospitalizations and continuous glucose monitor (CGM) utilization in approximately 1600 patients in 1 year periods preceding and following the local imposition of COVID-related restrictions on 3/15/2020 (“2019” and “2020” groups, respectively).ResultsIn a generalized linear model, increasing age, non-commercial insurance, Black and Hispanic race/ethnicity, and non-utilization of CGMs were all associated with higher hemoglobin A1c (HbA1c), but there was no difference between the 2019 and 2020 groups. The time in range in CGM users was lower with non-commercial insurance and in Black and Hispanic patients; it improved slightly from 2019 to 2020. CGM utilization by patients with non-commercial insurance (93% of such patients were in government programs, 7% uninsured or “other”) increased markedly. In 2020, patients with commercial insurance (i.e., private-pay or provided by an employer) had fewer office visits, but insurance status did not influence utilization of the virtual visit platform. There was no change in hospitalization frequency from 2019 to 2020 in either commercially or non-commercially insured patients, but patients with non-commercial insurance were hospitalized at markedly higher frequencies in both years. PHQ-9 scores were unchanged.ConclusionsHospitalization frequency, glycemic control and depression screening were unchanged in our large urban pediatric teaching hospital during the COVID pandemic. Increased utilization of CGM and rapid adoption of telemedicine may have ameliorated the impact of the pandemic on disease management.

The efficiency-thoroughness trade-off after implementation of electronic medication management: a qualitative study in paediatric oncology.

The efficiency-thoroughness trade-off (ETTO) principle proposes that people and organizations are often required to make a trade-off between being efficient and being thorough, as it is difficult to be both efficient and thorough at the same time. This study aimed to compare pre- electronic medication management system (EMMS) expectation of how an EMMS is likely to impact on efficiency and thoroughness to post-EMM experiences of an EMMS and the ETTO. Qualitative interview study. A paediatric oncology cancer centre in a large paediatric tertiary teaching hospital in Sydney, Australia. Forty-four semi-structured interviews with doctors, nurses and pharmacists six months prior to and two years following implementation of an EMMS. Prior to EMM implementation, staff identified a number of areas of work where both efficiency and thoroughness were expected to improve with EMM. These included ease of accessibility of the medication record, and organization and legibility of medication information. Following EMMS implementation, staff reported improvements in these areas. However, the EMMS was perceived to drive thoroughness (safety) benefits at the expense of efficiency (time). Measures to improve safety in the EMMS enforced processes that required time, such as medication double-checking procedures. Overall, staff were aware of the competitive interplay between thoroughness and efficiency and reported that introduction of an EMMS had imposed processes that favoured improvements in thoroughness at the expense of efficiency.

Evaluation of Healthcare-Acquired Infection Rates in a Pediatric Intensive Care Unit in Turkey

AbstractHealthcare-acquired infections (HAIs) have become a major concern and a significant cause of morbidity and mortality in pediatric intensive care units (PICUs). The purpose of this study was to evaluate HAI rates as well as the rates of invasive device utilization at a PICU at a large tertiary care pediatric teaching hospital from a developing country over a 4-year period, and to compare findings with those of the National Health Safety Network United States, the International Nosocomial Infection Control Consortium, and Turkey's national HAI rates. An active prospective surveillance was performed at a tertiary care PICU from January 2014 to December 2017. It was especially analyzed for nosocomial infections, related to invasive devices: the central line catheter (CL), mechanical ventilator (MV), and the urinary catheter (UC). During the 4-year period, a total of 2,855 patient admissions and 30,499 patient-days were evaluated. The device-associated (DA)-HAI incidence density was 17.57 per 1,000 patient-days, and the incidence rate was 18.8 per 100 admissions. The most common site of the DA-HAIs was ventilator-associated pneumonia (VAP) with the highest rate (60.9%). The second was the central line-associated bloodstream infection (CLA-BSI) rate (24.8%). Catheter-associated urinary tract infections (CA-UTI) rank third (14.3%). The HAI location was VAP in 187 patients (11.31/1,000 MV-days), CLA-BSI in 76 patients (4.39/1,000 CL-days), and CA-UTI in 44 patients (3.35/1,000 UC-days). The most frequent pathogens, isolated from the overall DA-HAIs as being causative microorganisms were Acinetobacter baumannii (23%), followed by Pseudomonas aeruginosa (14%). Resistance of Acinetobacter baumannii to Carbapenem was 76.47%, and methicillin-resistance Staphylococcus aureus was 50% at the pediatric ICU. This study reported data on incidence rates as well as pathogens of HAIs from a developing country's PICU, which may later supply useful data about other pediatric hospitals.

Abstract P088: Assessing the Use of a Preventive Cardiology Lifestyle Screening (PCLS) Tool in a Pediatric Sub-Specialty Lipid Clinic

Objective: Lifestyle modification is recommended to improve cholesterol levels in the pediatric population with the goal of reducing CVD risk. Existing tools assessing pediatric lifestyle habits are cumbersome and lack specificity. We developed the Preventive Cardiology Lifestyle Screen (PCLS) to assess behaviors relevant to CVD risk, and evaluated its use in a subspecialty lipid clinic at a large pediatric teaching hospital. Methods: Eligible participants were 2-21 years old, English speaking and presenting for care in a pediatric lipid clinic. We evaluated test-retest agreement using weighted kappa statistics, and validity of PCLS compared to longer research questionnaires [Block Food and Activity Questionnaires and Rapid Eating Assessment for Patients (REAP)] using Spearman correlation coefficients. Results: Participants (n = 138) had a mean age of 13 years; 50% were female, 22% reported a household income <$50,000. Median non-HDL cholesterol was 149.2 mg/dL and HDL cholesterol was 48 mg/dL. Of participants 2-17 years old (n=122), 15% were overweight and 46% were obese. Test re-test agreement for those ≥10 years (n=24) was good (weighted kappa >.75) for fruits and vegetables (0.83, 0.82 respectively), chicken no skin (0.89), processed meats (0.78) and sports drinks (.75). Test-retest agreement was poor (weighted kappa <.50) for regular soda intake (0.40), regular fat dairy (0.47), and eating lunch (0.45). Activity (sports 0.94 gym class 0.77) and inactivity (weekend video games 0.88 hours of sleep 0.78) overall had high test-retest agreement for most questions. Examining across dietary domains, the PCLS performed well at baseline compared to the BLOCK and REAP surveys in the domains of saturated fat, glycemic index, sodium and fiber (Table 1). Conclusion: The PCLS performed well on test re-test agreement, and responses correlated with previously validated research tools in most domains. This tool shows promise for use in the care of children with CVD lipid disorders.

Living With Moral Distress: The Perspectives and Experiences of Iranian Nurse Preceptors.

Background and Purpose: Preceptors play a key role in the transition experience of new nurses. Preceptorship is a stressful role and is influenced by contextual factors. There is a lack of sufficient understandings of the perspectives and lived experiences of Iranian nurse preceptors of preceptorship. The aim of this study was to explore the perspective and lived experiences of Iranian nurse preceptors of preceptorship. Methods: A qualitative design using a hermeneutic phenomenological approach was used. Six Iranian nurse preceptors were chosen using a purposeful sampling method from a large paediatric teaching hospital in an urban area of Iran. Data was collected using in-depth semi-structured interviews and was analysed using the Diekelmann et al.'s method of hermeneutic phenomenological analysis. Results: The data analysis resulted in the development of a constitutive pattern of 'living with moral distress', which was constituted of two major themes: 'asking for and being unable' and 'the experience of conflict'. Implications for Practice: The findings of this study can improve nurses' understandings of the preceptor's role and associated factors influencing the implementation of the preceptorship programme. 'Moral distress' caused by the preceptor role can influence nurse preceptors' mental health and also the patient care outcomes. More studies are required to explore this phenomenon in different contexts and cultures and design strategies for reducing the burden of taking this role on nurse preceptors. Also, policies are needed for developing a formal preceptor support system to help preceptors take this stressful and demanding role in healthcare settings.

Using quality improvement methods to reduce clear fluid fasting times in children on a preoperative ward.

We applied quality improvement (QI) methodology to identify the different aspects of why children fasted for prolonged periods in our institution. Our aim was for 75% of all children to be fasted for clear fluid for less than 4 hours. Prolonged fasting in children can increase thirst and irritability and have adverse effects on haemodynamic stability on induction. By reducing this, children may be less irritable, more comfortable and more physiologically stable, improving the preoperative experience for both children and carers. We conducted a QI project from January 2014 until August 2016 at a large tertiary pediatric teaching hospital. Baseline data and the magnitude of the problem were obtained from pilot studies. This allowed us to build a key driver diagram, a process map and conduct a failure mode and effects analysis. Using a framework of Plan-Do-Study-Act cycles our key interventions primarily focused on reducing confusion over procedure start times, giving parents accurate information, empowering staff and reducing variation by allowing children to drink on arrival (up to one hour) before surgery. Prior to this project, using the 6,4,2 fasting rule for solids, breast milk, and clear fluids, respectively, 19% of children were fasted for fluid for less than 4 hours, mean fluid fasting time was 6.3 hours (SD 4.48). At the conclusion 72% of patients received a drink within 4 hours, mean fluid fasting reduced to 3.1 hours (SD 2.33). The secondary measures of aspiration (4.14:10 000) and cancellations have not increased since starting this project. By using established QI methodology we reduced the mean fluid fasting time for day admissions at our hospital to 3.1 hours and increased the proportion of children fasting for less than 4 hours from 19% to 72%.

Selecting appropriate gastroenteric contrast media for diagnostic fluoroscopic imaging in infants and children: a practical approach.

In our experience, questions about the appropriate use of enteric contrast media for pediatric fluoroscopic studies are common. The purpose of this article is to provide a comprehensive review of enteric contrast media used for pediatric fluoroscopy, highlighting the routine use of these media at a large tertiary care pediatric teaching hospital.

The Use of Enteric Contrast Media for Diagnostic CT, MRI, and Ultrasound in Infants and Children: A Practical Approach.

Enteric contrast media are commonly administered for diagnostic cross-sectional imaging studies in the pediatric population. The purpose of this manuscript is to review the use of enteric contrast media for CT, MRI, and ultrasound in infants, children, and adolescents and to share our experiences at a large tertiary care pediatric teaching hospital. The use of enteric contrast material for diagnostic imaging in infants and children continues to evolve with advances in imaging technology and available enteric contrast media. Many principles of enteric contrast use in pediatric imaging are similar to those in adult imaging, but important differences must be kept in mind when imaging the gastrointestinal tract in infants and children, and practical ways to optimize the imaging examination and the patient experience should be employed where possible.

A Module-Based Pediatric ECG Curriculum to Improving Accuracy of ECG Interpretation by Pediatric Emergency Medicine Providers

OPEN ACCESSApril 24, 2014A Module-Based Pediatric ECG Curriculum to Improving Accuracy of ECG Interpretation by Pediatric Emergency Medicine Providers Priya Gopwani, MD, Shilpa Patel, E. Anne Greene, Jennifer Chapman Priya Gopwani, MD Children's National Medical Center Google Scholar More articles by this author , Shilpa Patel Children's National Medical Center Google Scholar More articles by this author , E. Anne Greene Children's National Medical Center Google Scholar More articles by this author , Jennifer Chapman Children's National Medical Center Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9779 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: Electrocardiograms (ECGs) are ordered frequently in the pediatric emergency department (ED). The majority of these ECGs are interpreted initially by pediatric emergency medicine (PEM) physicians, with a cardiologist reinterpreting the ECG after patient disposition has been made. Previous studies have shown that neither emergency medicine nor pediatric residency training programs adequately train residents to read ECGs. We designed a web-based pediatric ECG curriculum aimed specifically at fellow and attending PEM providers. The overall goal of this curriculum is to improve the “first read” accuracy of ECG interpretation and decrease the number of missed diagnoses. Methods: The curriculum consists of seven web-based modules focusing on pediatric ECGs and their interpretation in the ED setting. These modules cover the basics of pediatric ECGs, long QT syndrome & brugada, supraventricular tachycardia and Wolff Parkinson White syndrome, heart block and sick sinus syndrome, ventricular tachycardia, ischemia and infarct, and congenital heart disease. The case-based modules run for 7-12 minutes and are interactive, requiring the user to recognize abnormalities and perform necessary calculations before proceeding. Results: This module was administered to PEM fellows at a large urban pediatric teaching hospital. A pretest consisting of 20 ECGs was administered to all PEM fellows and a self-selected group of PEM attendings. At the completion of the curriculum, a posttest was administered to assess improvement. The average accuracy of identifying the ECG abnormality at pretest was 42.8% (PEM Fellows M = 40.6%, N = 9; PEM Attendings M = 45.7% N = 7). All nine fellows completed the posttest. There was a statistically significant improvement in the PEM fellows' ability to accurately interpret ECG findings using these modules were used (42.0% v 53.1%, p = .047, Wilcoxon Signed-Rank test). On an accompanying satisfaction survey, 100% would recommend the curriculum to a colleague and 76.5% thought the ECG modules could stand alone in teaching ECG interpretation to PEM providers. Discussion: There is a need to improve the ability of PEM physicians to read ECGs, particularly those with clinically significant findings. We designed a web-based pediatric ECG curriculum aimed specifically at PEM providers with the overall goal of improving the “first read” accuracy of ECG interpretation and to decrease the number of missed diagnoses. Based on learner feedback, we determined that the implementation of a combined module-based and didactic pediatric ECG curriculum improved the ability of PEM fellows to accurately interpret ECGs with abnormalities. Educational Objectives By the end of this session, learners will be able to: Demonstrate a systematic approach to reading pediatric ECGs.Describe clinically significant findings on pediatric ECGs.Formulate the initial treatment plan for pediatric patients with clinically significant findings on ECGs. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: MedEdPORTAL Instructors Guide.docx ECG Basics.mp4 LQTS Brugada.swf SVT and WPW.swf HB and SSS.swf VT.swf Ischemia Infarct.swf Congenital Heart Disease.swf To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2014 Gopwani et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivatives license.KeywordsPediatricsElectrocardiographyPediatric Emergency MedicineElectrocardiogramsECGs Disclosures None to report. Funding/Support None to report. Loading ...

Pilotprojekt einer pädiatrischen Antibiotic-Stewardship-Initiative am Dr. von Haunerschen Kinderspital - neue Wege der pädiatrischen Infektiologie

The steady increase in antimicrobial resistance is of growing concern in healthcare. Antibiotic Stewardship [ABS] Strategies are important tools to control antibiotic use and -prevent antimicrobial resistance. An increasing number of institutions are developing ABS initiatives also in pediatrics. However, few data are available assessing the implementation and efficiency of these pediatric ABS programs.At the Dr. von Hauner Children's Hospital, Ludwig-Maximilian University, a tertiary care pediatric reference center, a pediatric ABS Team has been implemented. Key structural elements were the same as for adult patients, but antimicrobials agents selected for monitoring and appropriate clinical endpoints are different in pediatrics.Key features were: 1. prospective-audit with feedback and formulary restriction and 2. pre-authorization (also referred to as prior approval). The ABS team consisted of one pediatric infectious disease specialist, one clinical fellow in pediatric infectious diseases, and one clinical pharmacist with training in infectious diseases.With the implementation of a pediatric ABS strategy we could significantly influence antimicrobial consumption in our hospital. Cost-savings are estimated to be above 330 000 € per year, and concomitantly the use of broad-spectrum antibiotics and antifungal compounds was significantly reduced.Antibiotic Stewardship [ABS] Strategies may be an effective tool to control antibiotic use in the setting of a large tertiary pediatric teaching hospital. A national guideline for ABS initiatives may help to further improve rational use of antibiotics in the hospital setting.

G187(P) Causes of Severe Anaemia (Hb

Severe childhood anaemia risks significant morbidity and mortality though may have different benign or malignant aetiologies. We set out to define the characteristics of this group of patients at our...

Part 10: Paediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

Part 10: Paediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

FIRST: A Practical Approach to the Causes and Management of Febrile Seizures

During almost 4 decades of clinical practice of pediatrics and pediatric neurology, the senior authors have rarely made a formal presentation on the topic of "febrile seizures." In any large pediatric teaching hospital, questions regarding the diagnosis and management of febrile seizures are raised by medical students, pediatric residents, and adult and pediatric neurology residents. The acronym FIRST was developed as a teaching tool to present a simple and pragmatic clinical approach to children presenting with a single seizure or cluster of seizures in 1 day associated with a febrile illness before, during, or after the seizure event(s). FIRST refers to Febrile, Illness, Related, Seizure(s) and Template, with the latter representing an outline of the basic cause(s). The authors propose the use of the Table as a tool to help determine the underlying etiology of febrile seizures because this is the major factor affecting the choice of treatment.

A Conceptual Model and Practice Framework for Managing Chronic Pain in Children and Adolescents

Pain is a complex phenomenon: a sensory experience originating in traumatized tissues; an emotional (affective) experience that signals danger in the internal (body) or external environment; and a "disposition to act" that results either in "action" that prioritizes escape or in "inhibition of action" to minimize injury or facilitate healing. Recent advances in our understanding of the affective components of pain have significant implications for the treatment of chronic pain in children and adolescents. This article describes a chronic pain clinic for children and adolescents developed by the pain service of a large pediatric teaching hospital. Pain is conceptualized and managed in terms of multiple, interrelating systems (the body level, the psychological level, and the social level). This model of care is illustrated with reference to the management of two cases of children with chronic pain and significant functional impairment. A brief overview of the care utilization of 62 children referred to the Chronic Pain Clinic is also provided, with the clinical characteristics of 40 children with somatoform pain disorder (SPD) being described in more detail. Of 28 children with SPD treated with our systems intervention, 82% reported significant reductions in pain intensity, 71% returned to school full time, and 29% part time. An advantage of this integrated, family-based assessment and treatment approach is the overarching emphasis on identifying the contribution of each system to the child's subjective experience of pain, thereby avoiding the deleterious polarization of the pain as either physical or psychogenic in origin.

Development of Guidelines for Determining Frequency of Therapy Services in a Pediatric Medical Setting

The purpose of this article is to describe guidelines for frequency of therapy services that were developed to help physical therapists and occupational therapists determine appropriate utilization of therapy services in a pediatric medical setting. The guidelines were developed for use by physical and occupational therapists when treating inpatients and outpatients at a large urban Midwest pediatric teaching hospital. Factors for consideration when determining frequency of therapy were adapted from the existing literature. Four modes of service delivery were developed; intensive (3 to 11 times a week), weekly or bimonthly (1 to 2 times a week to every other week), periodic (monthly or less often but at regularly scheduled intervals), and consultative (episodic or as needed). Descriptions are provided in a table format with factors to consider when making treatment frequency decisions. These guidelines have been helpful to therapists in this medical setting when communicating therapy needs and goals to families and other professionals.

Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit*

We implemented a medical emergency team (MET) in our free-standing children's hospital. The specific aim was to reduce the rate of codes (respiratory and cardiopulmonary arrests) outside the intensive care units by 50% for >6 months following MET implementation. Retrospective chart review and program implementation. A children's hospital. None. The records of patients who required cardiorespiratory resuscitation outside the critical care areas were reviewed before MET implementation to determine activation criteria for the MET. Codes were prospectively defined as respiratory arrests or cardiopulmonary arrests. MET-preventable codes were prospectively defined. The incidence of codes before and after MET implementation was recorded. Twenty-five codes occurred during the pre-MET baseline compared with six following MET implementation. The code rate (respiratory arrests + cardiopulmonary arrests) post-MET was 0.11 per 1,000 patient days compared with baseline of 0.27 (risk ratio, 0.42; 95% confidence interval, 0-0.89; p = .03). The code rate per 1,000 admissions decreased from 1.54 (baseline) to 0.62 (post-MET) (risk ratio, 0.41; 95% confidence interval, 0-0.86; p = .02). For MET-preventable codes, the code rate post-MET was 0.04 per 1,000 patient days compared with a baseline of 0.14 (risk ratio, 0.27; 95% confidence interval, 0-0.94; p = .04). There was no difference in the incidence of cardiopulmonary arrests before and after MET. For codes outside the intensive care unit, the pre-MET mortality rate was 0.12 per 1,000 days compared with 0.06 post-MET (risk ratio, 0.48; 95% confidence interval, 0-1.4, p = .13). The overall mortality rate for outside the intensive care unit codes was 42% (15 of 36 patients). Implementation of a MET is associated with a reduction in the risk of respiratory and cardiopulmonary arrest outside of critical care areas in a large tertiary children's hospital.

CT of appendicitis in children.

Appendicitis is the most common condition requiring intraabdominal surgery in infancy and childhood. Yet, despite its common occurrence, accurate diagnosis remains challenging. Acute appendicitis may be missed at initial clinical examination in 28%-57% of children aged 12 years and younger and in nearly 100% of children under the age of 2 years. Diagnostic imaging has an ever-increasing role in the prompt and accurate diagnosis of acute appendicitis in the pediatric population. At the authors' institution, helical computed tomography (CT) is the primary tool for diagnosing or excluding appendicitis in children. Since its inception in 1998, helical CT with rectally administered contrast material has been shown to reduce the total number of inpatient observation days, laparotomies with negative findings, and per-patient cost. Helical CT is a highly sensitive and specific tool for diagnosing pediatric appendicitis and has resulted in a beneficial change in patient care in 68.5% of all patients seen in the authors' emergency department for suspected appendicitis. This includes both those patients who receive an eventual diagnosis of appendicitis and those who do not have the disease. Major strengths of limited helical CT with rectal contrast material include producing uniformly high published sensitivity and specificity values for diagnosis of appendicitis and enabling diagnosis of alternative conditions of acute abdominal pain in children. In contrast, limitations of graded-compression ultrasonography in children include highly operator-dependent sensitivity and specificity values and relative infrequency with which the normal appendix can be visualized in this population. Although there have been many exciting diagnostic advancements for the diagnosis of acute appendicitis in the pediatric population, the role of helical CT is far from clear. The purpose of this article is to describe a helical CT approach to imaging in children suspected of having acute appendicitis at a large urban pediatric teaching hospital and its effects on patient outcomes and hospital costs.