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Fri, 11 Apr 2003 20:11:26 -0500

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I never said it was my preference.  I never said that I thought that it =
was right.  I said, that outside of the ivory tower it happens very =
frequently. =20

I, personally, have NOT used CT scan for evaluation of right lower =
quadrant pain.  I have no intention of using it either. =20

Appendicitis in a young adult is a "fun" diagnosis.  You have the march =
of syndromes matched with a physical exam that may include Rovsing's and =
the psoas sign.  With the addition of a white blood cell count the =
"good" clinician should be able to get the right diagnosis better than =
80% of the time (in men, somewhat less in women).  The operation (open =
or closed) is also quick and fun (for the surgeon). =20

A CT of the abdomen would break up this party in my opinion.=20

E

Errington C. Thompson, MD, FACS
Trauma Surgeon
Trinity Mother Frances
Tyler, Tx.
ecthompson@tyler.net

Don't think you are
Know you are
=20
                           - Morpheus (The Matrix)

  ----- Original Message -----=20
  From: KMATTOX@aol.com=20
  To: trauma-list@trauma.org=20
  Sent: Friday, April 11, 2003 6:49 PM
  Subject: Appendicitis & CT=20

  I do not understand why anyone anywhere at any time  would use CT to =
DIAGNOSE acute appendicitis.    I personally believe that a quality =
outcome measurement ought to be ANY physician that orders a CT to  rule =
out appendicitis should have to face a QA board and if the QA board =
deems that it was unnecessary, that physician must pay for the entire =
patient's hospitalization, by payroll  deductions.    =20

  k 
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<DIV>I never said it was my preference.&nbsp; I never said that I =
thought that=20
it was right.&nbsp; I said, that outside of the ivory tower it happens =
very=20
frequently.&nbsp; </DIV>
<DIV>&nbsp;</DIV>
<DIV>I, personally, have NOT used CT scan for evaluation of right lower =
quadrant=20
pain.&nbsp; I have no intention of using it either.&nbsp; </DIV>
<DIV>&nbsp;</DIV>
<DIV>Appendicitis in a young adult is a "fun" diagnosis.&nbsp; You have =
the=20
march of syndromes matched with a physical exam that may include =
Rovsing's and=20
the psoas sign.&nbsp; With the addition of a white blood cell count the =
"good"=20
clinician should be able to get the right diagnosis better than 80% of =
the time=20
(in men, somewhat less in women).&nbsp; The operation (open or closed) =
is also=20
quick and fun (for the surgeon).&nbsp; </DIV>
<DIV>&nbsp;</DIV>
<DIV>A CT of the abdomen would break up this party in my opinion. </DIV>
<DIV>&nbsp;</DIV>
<DIV>E</DIV>
<DIV>&nbsp;</DIV>
<DIV>Errington C. Thompson, MD, FACS<BR>Trauma Surgeon<BR>Trinity Mother =

Frances<BR>Tyler, Tx.<BR><A=20
href=3D"mailto:ecthompson@tyler.net">ecthompson@tyler.net</A></DIV>
<DIV>&nbsp;</DIV>
<DIV>Don't think you are<BR>Know you=20
are<BR>&nbsp;<BR>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&n=
bsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;=20
- Morpheus (The Matrix)<BR></DIV>
<BLOCKQUOTE dir=3Dltr=20
style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; =
BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">
  <DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV>
  <DIV style=3D"FONT: 10pt arial"><B>From:</B> <A =
title=3DKMATTOX@aol.com=20
  href=3D"mailto:KMATTOX@aol.com">KMATTOX@aol.com</A> </DIV>
  <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A =
title=3Dtrauma-list@trauma.org=20
  href=3D"mailto:trauma-list@trauma.org">trauma-list@trauma.org</A> =
</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Friday, April 11, 2003 =
6:49=20
PM</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> Appendicitis &amp; CT =
</DIV>
  <DIV><BR></DIV>
  <DIV><FONT face=3Darial,helvetica><FONT lang=3D0 face=3DArial size=3D2 =

  FAMILY=3D"SANSSERIF">I do not understand why anyone anywhere at any =
time&nbsp;=20
  would use CT to DIAGNOSE acute appendicitis.&nbsp;&nbsp;&nbsp; I =
personally=20
  believe that a quality outcome measurement ought to be ANY physician =
that=20
  orders a CT to&nbsp; rule out appendicitis should have to face a QA =
board and=20
  if the QA board deems that it was unnecessary, that physician must pay =
for the=20
  entire patient's hospitalization, by payroll&nbsp;=20
  deductions.&nbsp;&nbsp;&nbsp;&nbsp; <BR><BR>k</FONT>=20
</FONT></DIV></BLOCKQUOTE></BODY></HTML>

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Appendicitis & CT