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Appendicitis & CT

pedromtt meza trauma-list@trauma.org
Wed, 23 Apr 2003 15:45:28 -0700 (PDT)


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If I may add, it helps in case it goes to court, provided something goes wrong.  Murphy's Law.  Pedro  Meza

Ronald Simon <Traumamd@nyc.rr.com> wrote: Yea you could admit and observe but i you asked the parents about where they'd rather sleep there answer would be home. Why admit if you can safely send the kid home? The other benefit is for the kid with early appendicitis who you would have admitted who now gets his operation 12-24hrs earlier and therefore home earlier. Big advantage,.
Ron

Avi Roy Shapira wrote:

Ron and Meredith,  Both of you have answered similarly: What I hear u saying is that if theyhave a reliable home, and they don't need re-hydration or pain control yousend them home if the CT is negative, telling them to return in themorning for a second examination.I don't really see the role of the CT in your game plan.  Realy whetherthe patinet stays in the hospital or goes home is not very important,Afterall, unless the patient's worsens, the next observation in thehosptial will be at morning rounds. So as long as you can trust thepatient to return should he/she get worse, and make sure you see him orher the next day, you can safely send them home, even without the CT, The point is that by your own admission, you both rely on your goodclinical judgement to make the diagnosis.  The CT adds little, exceptperhaps give you a false sense that you have YAC.Avi   

Avi Roy Shapira wrote:    

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        

You may doubt if you wish but if there is a reliable home then that is where they go.Ron    

==========================================================================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.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/traumalist.html  




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<DIV>
<DIV>If I may add, it helps in case it goes to court, provided something goes wrong.&nbsp; Murphy's Law.&nbsp; Pedro&nbsp; Meza<BR><BR><B><I>Ronald Simon &lt;Traumamd@nyc.rr.com&gt;</I></B> wrote: 
<BLOCKQUOTE style="PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #1010ff 2px solid">Yea you could admit and observe but i you asked the parents about where they'd rather sleep there answer would be home. Why admit if you can safely send the kid home? The other benefit is for the kid with early appendicitis who you would have admitted who now gets his operation 12-24hrs earlier and therefore home earlier. Big advantage,.<BR>Ron<BR><BR>Avi Roy Shapira wrote:<BR>
<BLOCKQUOTE cite=midPine.OSF.4.21.0304231944430.26860-100000@sansana.bgu.ac.il type="cite"><PRE wrap="">Ron and Meredith,  

Both of you have answered similarly: What I hear u saying is that if they
have a reliable home, and they don't need re-hydration or pain control you
send them home if the CT is negative, telling them to return in the
morning for a second examination.

I don't really see the role of the CT in your game plan.  Realy whether
the patinet stays in the hospital or goes home is not very important,
Afterall, unless the patient's worsens, the next observation in the
hosptial will be at morning rounds. So as long as you can trust the
patient to return should he/she get worse, and make sure you see him or
her the next day, you can safely send them home, even without the CT, 

The point is that by your own admission, you both rely on your good
clinical judgement to make the diagnosis.  The CT adds little, except
perhaps give you a false sense that you have YAC.

Avi 




  </PRE>
<BLOCKQUOTE type="cite"><PRE wrap="">Avi Roy Shapira wrote:

    </PRE>
<BLOCKQUOTE type="cite"><PRE wrap="">On Tue, 15 Apr 2003, Ronald Simon wrote:

 

      </PRE>
<BLOCKQUOTE type="cite"><PRE wrap="">The question is whether it is more cost effective to CT and send home 
those "tuff" cases vs admit and observe.
   

        </PRE></BLOCKQUOTE><PRE wrap="">Have you ever sent them home with a negative CT? I doubt it. 

Avi 

 

      </PRE></BLOCKQUOTE><PRE wrap="">You may doubt if you wish but if there is a reliable home then that is 
where they go.
Ron

    </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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