Hi Frank,
At Children's Memorial Hermann in the Texas Medical Center, We are
fortunate to have both 24/7 US and MRI.
Like Dr. Skarbek-Borowska, we generally start with US, if non-diagnostic,
we usually order the Fast MRI Abd/Pelvis.
Can't remember the last time a CT was ordered for appendicitis (or for VP
shunt malfunction).

Our faculty, as well as our pediatric surgeons, are committed to
eliminating the use of CT for pediatric appendicitis. We actually routinely
visit other hospitals in our system, as well as free standing ECs, to
inform them we are happy to take their transfers for pediatric suspected
appendicitis, without any imaging.

You could argue that having 24/7 of either US or MRI, will potentially save
an observation bed and increase transfers from places wanting to minimize
radiation exposure in peds (not sure if that's an issue in RI).  Stronger
argument for MRI, since you're more likely to have a diagnosis with the MRI
vs US, but I imagine it's a harder to ask for 24/7 MRI vs 24/7 US, unless
there is need elsewhere in your hospital for MRI around the clock
(Neurosurgery patients?).
Our scenario may be different though, since we are within an adult
hospital, with robust MRI usage for adult problems, there was no need to
"expand MRI service hours", for us, Fast MRI abd/pelvis without contrast,
is cost neutral or cheaper than CT abd/pelvis with contrast.

Kudos for admitting for US vs CT and possibly discharge home.

Happy to discuss further offline.

Robert M Lapus MD
Assistant Professor and Director of Pediatric Clinical Operations
McGovern Medical School at UTHealth
Director of Pediatric Emergency Services
Children's Memorial Hermann Hospital
Houston TX

On Thu, Jul 14, 2016 at 11:17 AM, Frank Overly, MD <[log in to unmask]>

> I know this has been discussed, but it has been several years when I
> search the archives.  We are getting ready to sit down with our surgeons
> and radiologists (again) to discuss standard of care for evaluation of
> pediatric patients with RLQ pain.  Our institution only has US for r/o appy
> until 5pm and after that we are challenged with how to evaluate these
> patients.  We rarely CT, only occasionally MRI, frequently either admit for
> US next day or send home for US next day.
> I am curious to know what others are doing, to hopefully strengthen our
> argument for either US 24/7 or possibly MRI when US not available.
> Appreciate any info.
> thanks
> Frank
> Frank L. Overly, MD, FAAP
> Associate Professor
> Emergency Medicine and Pediatrics
> Alpert Medical School of Brown University
> Medical Director
> Pediatric Emergency Department
> Hasbro Children’s Hospital
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