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Home > List Archives

Appendicitis & CT

tony joseph trauma-list@trauma.org
Fri, 25 Apr 2003 09:48:47 +1000


At 10:34 PM 23/04/03 EDT, you wrote:
Ken
If the CT or ultrasound was only reserved for the difficult or unclear
cases that is acceptable, but where it becomes almost mandatory ( and often
requested by the Surgeons) to the exclusion of clinical judgement, then it
becomes a problem. The key issue is that clinical judgement seems to differ
between individuals and it is that which determines if you wait 2 or 24
hours for your appendicectomy. 
Tony Joseph

>
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 
>called.   
>
>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 
>visit.  
>
>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
>
>k
>
>
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