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Home > List Archives

Appendecitis and CT

trauma-list@trauma.org trauma-list@trauma.org
Sun, 13 Apr 2003 12:54:46 EDT


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Dr. Stafford:    If, I and I believe that it is, this forum is an attempt to 
optimize our treatments of patients, and to eliminate urban legends, then the 
recent posts do just that.  If you feel that you or anyone else is on this 
list, is being bashed, then I would suggest to the other readers that you are 
oversensitive.   What is being asked for is evidence that CT is of 
significant benefit in the evaluation of a surgical abdomen which turns out 
to be appendicitis.   I have not seen that evidence either in our own 
practice, or in the literature.   I am very familiar with the printed 
literature on this subject and submit that Class I, II, or III data does NOT 
exist to support the use of CT in the algorithm for the evaluation of 
appendicitis.   I am aware of the pediatric surgery literature regarding teen 
age females, ultrasound, and ovarian cysts, but we are not talking about 
ultrasound here, we are talking about CT.   CT is a wonderful and expensive 
modality where it is appropriately applied.  In this day of escalating 
medical costs, where else but a forum like this do we find the truth, and 
participate in the run away costs that we and our pens are responsible for, 
in a large part.   

Surgery and the evaluation of a surgical patient is a disciplined profession, 
with both organizational and personal discipline.   It is that discipline 
that I sought when I required surgery last year, not some practice by 
committee and cost over runs, just because someone needed to be fed at the 
insurance trough and order tests, medications and services.    In my humble 
view, CT ordered in a case of appendicitis even before the surgeon is asked 
for his/her judgment is simply put, unnecessary, uninformed (I think I used 
the word stupid before and I will stand by it), and adds extra expense.  If 
anyone, including you, has evidence that we should be using CT in the 
evaluation of a patient with appendicitis, then please, PLEASE supply that 
data.  

k

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<HTML><FONT FACE=3Darial,helvetica><FONT  SIZE=3D2 FAMILY=3D"SANSSERIF" FACE=
=3D"Arial" LANG=3D"0">Dr. Stafford:&nbsp;&nbsp;&nbsp; If, I and I believe th=
at it is, this forum is an attempt to optimize our treatments of patients, a=
nd to eliminate urban legends, then the recent posts do just that.&nbsp; If=20=
you feel that you or anyone else is on this list, is being bashed, then I wo=
uld suggest to the other readers that you are oversensitive.&nbsp;&nbsp; Wha=
t is being asked for is evidence that CT is of significant benefit in the ev=
aluation of a surgical abdomen which turns out to be appendicitis.&nbsp;&nbs=
p; I have not seen that evidence either in our own practice, or in the liter=
ature.&nbsp;&nbsp; I am very familiar with the printed literature on this su=
bject and submit that Class I, II, or III data does NOT exist to support the=
 use of CT in the algorithm for the evaluation of appendicitis.&nbsp;&nbsp;=20=
I am aware of the pediatric surgery literature regarding teen age females, u=
ltrasound, and ovarian cysts, but we are not talking about ultrasound here,=20=
we are talking about CT.&nbsp;&nbsp; CT is a wonderful and expensive modalit=
y where it is appropriately applied.&nbsp; In this day of escalating medical=
 costs, where else but a forum like this do we find the truth, and participa=
te in the run away costs that we and our pens are responsible for, in a larg=
e part.&nbsp;&nbsp; <BR>
<BR>
Surgery and the evaluation of a surgical patient is a disciplined profession=
, with both organizational and personal discipline.&nbsp;&nbsp; It is that d=
iscipline that I sought when I required surgery last year, not some practice=
 by committee and cost over runs, just because someone needed to be fed at t=
he insurance trough and order tests, medications and services.&nbsp;&nbsp;&n=
bsp; In my humble view, CT ordered in a case of appendicitis even before the=
 surgeon is asked for his/her judgment is simply put, unnecessary, uninforme=
d (I think I used the word stupid before and I will stand by it), and adds e=
xtra expense.&nbsp; If anyone, including you, has evidence that we should be=
 using CT in the evaluation of a patient with appendicitis, then please, PLE=
ASE supply that data.&nbsp; <BR>
<BR>
k</FONT></HTML>

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