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Appendicitis & CT

Ronald Simon trauma-list@trauma.org
Tue, 15 Apr 2003 13:31:09 -0400


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The question is whether it is more cost effective to CT and send home 
those "tuff" cases vs admit and observe.
Ron Simon

Avi Roy Shapira wrote:

>Surely there is a limited place to CT in the diagnosis of acute lower
>quadrant abdominal pain. I think we all agree to that.  
>
>What I, with Doug and Eric, argue is that one should reserve the CT for
>the obscure cases.  Even then it should be delayed. 
>
>If the case is not clear cut, we usually admit the patient for
>observation. The majority of observed patients simply get better, and go
>home in 24h with no operation and no CT.  Few declare themselves and get
>an appendectoy; fewer still remain obscure and these get a CT.
>
>The practice which I and other responders do not condone is the routine CT
>of anyone with RLQ pain, often ordered before a surgeon had even seen the
>patient. 
>
>Avi 
>
>On Mon, 14 Apr 2003, Ronald Simon wrote:
>
>  
>
>>I don't get this. There are clearly some cases where the diagnosis is a 
>>slam dunk and no further studies necessary. But there are times when it 
>>is not. This is where 10-20% neg AP rate comes from. If you can do a 
>>test that will significantly reduce this negative rate why not use it? I 
>>would personally rather have a CT than a neg exploration as i assume my 
>>patients feel the same way.
>>Ron
>>
>>Douglas Geehan wrote:
>>
>>    
>>
>>>> To say the use of all CTs in acute AP is wrong is an overstatement.
>>>>Ron Simon
>>>>Dir of Trauma
>>>>Jacobi Medical Center
>>>>        
>>>>
>>>
>>>I would agree with this statement; howver, we have been discussing the 
>>>use of CT for appendicitis (kind of neat since we're on the trauma-L; 
>>>I guess that answers the question about segregated trauma/ gen surgery 
>>>call...) specifically.  My personal view is that you request a CT when 
>>>you think the patient does not have appendicitis.  As I tell my 
>>>residents, "If you are confident enough to put appendicitis as the 
>>>reason for the CT on the requisition form, the patient just needs an 
>>>operation".
>>>
>>>Doug
>>>
>>>      
>>>
>>
>>
>>--
>>trauma-list : TRAUMA.ORG
>>To change your settings or unsubscribe visit:
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>>
>>    
>>
>
>==========================================================================
>Aviel Roy-Shapira, M.D.              Soroka University Hospital &
>Dept. of Surgery A. and              Ben-Gurion University Medical School 
>the Critical Care Unit               POB 151, Beer Sheva, Israel
> 
>email:avir@bgumail.bgu.ac.il         Fax:972-7-6403260 voice:972-7-6403390
>
>
>
>
>--
>trauma-list : TRAUMA.ORG
>To change your settings or unsubscribe visit:
>http://www.trauma.org/traumalist.html
>
>  
>


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The question is whether it is more cost effective to CT and send home those
"tuff" cases vs admit and observe.<br>
Ron Simon<br>
<br>
Avi Roy Shapira wrote:<br>
<blockquote type="cite"
 cite=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2003-April/"midPine.OSF.4.21.0304151029200.9507-100000@sansana.bgu.ac.il">
  <pre wrap="">Surely there is a limited place to CT in the diagnosis of acute lower
quadrant abdominal pain. I think we all agree to that.  

What I, with Doug and Eric, argue is that one should reserve the CT for
the obscure cases.  Even then it should be delayed. 

If the case is not clear cut, we usually admit the patient for
observation. The majority of observed patients simply get better, and go
home in 24h with no operation and no CT.  Few declare themselves and get
an appendectoy; fewer still remain obscure and these get a CT.

The practice which I and other responders do not condone is the routine CT
of anyone with RLQ pain, often ordered before a surgeon had even seen the
patient. 

Avi 

On Mon, 14 Apr 2003, Ronald Simon wrote:

  </pre>
  <blockquote type="cite">
    <pre wrap="">I don't get this. There are clearly some cases where the diagnosis is a 
slam dunk and no further studies necessary. But there are times when it 
is not. This is where 10-20% neg AP rate comes from. If you can do a 
test that will significantly reduce this negative rate why not use it? I 
would personally rather have a CT than a neg exploration as i assume my 
patients feel the same way.
Ron

Douglas Geehan wrote:

    </pre>
    <blockquote type="cite">
      <blockquote type="cite">
        <pre wrap=""> To say the use of all CTs in acute AP is wrong is an overstatement.
Ron Simon
Dir of Trauma
Jacobi Medical Center
        </pre>
      </blockquote>
      <pre wrap="">

I would agree with this statement; howver, we have been discussing the 
use of CT for appendicitis (kind of neat since we're on the trauma-L; 
I guess that answers the question about segregated trauma/ gen surgery 
call...) specifically.  My personal view is that you request a CT when 
you think the patient does not have appendicitis.  As I tell my 
residents, "If you are confident enough to put appendicitis as the 
reason for the CT on the requisition form, the patient just needs an 
operation".

Doug

      </pre>
    </blockquote>
    <pre wrap="">


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    </pre>
  </blockquote>
  <pre wrap=""><!---->
==========================================================================
Aviel Roy-Shapira, M.D.              Soroka University Hospital &amp;
Dept. of Surgery A. and              Ben-Gurion University Medical School 
the Critical Care Unit               POB 151, Beer Sheva, Israel
 
<a class="moz-txt-link-freetext" href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2003-April/"email:avir@bgumail.bgu.ac.il">email:avir@bgumail.bgu.ac.il</a>         Fax:972-7-6403260 voice:972-7-6403390




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