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Appendicitis & CT

trauma-list@trauma.org trauma-list@trauma.org
Wed, 23 Apr 2003 22:34:21 EDT

I was hopeful that this subject was dead.  However, having been in court 
probably as much as any person on this list server, a CT scan obtained to aid 
in the diagnosis of appendicitis will DO NOTHING to help a physician 
(especially a non-surgeon) in case they are called to court.   For a long 
list of reasons, it will INCREASE that physicians liability.    

Remember what started this discussion.   It was a concern that emergency 
physicians, internist, and pediatricians were unnecessarily ordering CT scans 
prior to a surgeon seeing a patient.   The discussions supporting CT ALL 
(every one of them) stated that following clinical evaluation with history 
and physical examination, a surgeon might order a CT to rule out other 
non-appendicitis pathology.   

I will admit that when the surgeon thinks things do not compute, he/she might 
order additional tests, to look for something else, even up to and including 
myocardial infarction, pancreatitis, and even black widow spider bite,or even 
diabetes.   That is appropriate.   EVERY surgeon that responded to this list 
stated that if by history and physical examination the surgeon made a 
diagnosis, then the next evaluation is for the pathologist to examine the 
removed appendix.    

There was one suggestion of a value of ultrasound to look for an ovarian cyst 
in young women.  I do not necessarily disagree with that, especially if a 
corpus luteum cyst is suspected by history.   However, this was NOT the 
original discussion, the original discussion related to CTs ordered by non 
surgeons to rule in or rule out appendicitis, so that a surgeon would then be 

I stand by my original post that under these circumstances, and the 
circumstances originally presented  CT Scanning has NO place in the 
evaluation and diagnosis of appendicitis and should in every health care 
system in the world, should prompt a QA review for waste of money and 
following an inappropriate practice guideline.    I further suggest that the 
person that ordered the CT should pay for the entire hospitalization or EC 

I thought that the tenor of the list of posts which occurred on this subject 
two weeks ago settled this issue.   Why do we need to replow old ground