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Appendicitis & CT

trauma-list@trauma.org trauma-list@trauma.org
Thu, 24 Apr 2003 20:02:53 EDT


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In a message dated 4/23/2003 11:49:16 PM Eastern Daylight Time, 
pandanas@OregonFAST.net writes:

> Now, my question is, as a non surgeon, in a acute abdomen of non clear
> etiology, what do you do? to CT or not CT?
> 

You examine the patient (pretty novel, huh?), order a minimum of simple tests 
(maybe WBC, lipase, CXR, KUB), and then--use some clinical acumen.  And guess 
what?  In the great majority of these cases, nothing more is necessary!  
Surprised?  If so, you need a lot more experience with the acute abdomen and 
surgical diseases--and ordering more expensive and exotic tests does not 
substitute for some thinking, reading, studying and clinical experience.  It 
is done because the former is much easier, and usually only by those who have 
no responsibility for the ultimate care and welfare of the patient.  You must 
remember--before about 20 years ago there was no CT---and guess what?  The 
diagnosis of the acute abdomen was no different!  The use of CT has done 
NOTHING to improve diagnosis, reduce hospital stay, reduce morbidity, --it 
CERTAINLY increases costs--from diseases presenting with acute abdominal 
pain, over a large population.  IF you assert otherwise, please refer us all 
to the citation demonstrating such?  I will be happy to refer you to the data 
(for about the fourth time in the last 2 weeks) showing it has made no 
difference in a statewide population
ERF

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<HTML><FONT FACE=3Darial,helvetica><FONT  SIZE=3D2 FAMILY=3D"SANSSERIF" FACE=
=3D"Arial" LANG=3D"0">In a message dated 4/23/2003 11:49:16 PM Eastern Dayli=
ght Time, pandanas@OregonFAST.net writes:<BR>
<BR>
<BLOCKQUOTE TYPE=3DCITE style=3D"BORDER-LEFT: #0000ff 2px solid; MARGIN-LEFT=
: 5px; MARGIN-RIGHT: 0px; PADDING-LEFT: 5px">Now, my question is, as a non s=
urgeon, in a acute abdomen of non clear<BR>
etiology, what do you do? to CT or not CT?<BR>
</BLOCKQUOTE><BR>
<BR>
You examine the patient (pretty novel, huh?), order a minimum of simple test=
s (maybe WBC, lipase, CXR, KUB), and then--use some clinical acumen.&nbsp; A=
nd guess what?&nbsp; In the great majority of these cases, nothing more is n=
ecessary!&nbsp; Surprised?&nbsp; If so, you need a lot more experience with=20=
the acute abdomen and surgical diseases--and ordering more expensive and exo=
tic tests does not substitute for some thinking, reading, studying and clini=
cal experience.&nbsp; It is done because the former is much easier, and usua=
lly only by those who have no responsibility for the ultimate care and welfa=
re of the patient.&nbsp; You must remember--before about 20 years ago there=20=
was no CT---and guess what?&nbsp; The diagnosis of the acute abdomen was no=20=
different!&nbsp; The use of CT has done NOTHING to improve diagnosis, reduce=
 hospital stay, reduce morbidity, --it CERTAINLY increases costs--from disea=
ses presenting with acute abdominal pain, over a large population.&nbsp; IF=20=
you assert otherwise, please refer us all to the citation demonstrating such=
?&nbsp; I will be happy to refer you to the data (for about the fourth time=20=
in the last 2 weeks) showing it has made no difference in a statewide popula=
tion<BR>
ERF</FONT></HTML>

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