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Appendicitis & CT

Avi Roy Shapira trauma-list@trauma.org
Thu, 17 Apr 2003 03:47:18 +0300 (IDT)


On Tue, 15 Apr 2003, Ronald Simon wrote:

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

Have you ever sent them home with a negative CT? I doubt it. 

Avi 


> 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
> >>>
> >>>      
> >>>
> >>
> >>
> >>--
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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
> >
> >  
> >
> 
> 

==========================================================================
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