Tagging onto Randy's excellent response to Loren's questions:
Steve Gohsler, a fellow faculty here at Morristown, recently reviewed an
article in an Evidence-Based Medicine seminar being put on by a couple of
other partners in my group (Barney Eskin and John Allegra) on the use of
nonenhanced CT for appendicitis.
Lane MJ, et al: Suspected acute appendicitis: nonenhanced helical CT in 300
consecutive patients. Radiology 1999;213:341-346.
The likelihood ratio for having disease with a (+) scan was 45. If your
pre-test probability of disease is approx 50%, this gives you a post-test
probability of disease with a (+) scan of ~98%! Tell the surgeon to meet the
patient in the OR!
The neg likelihood ratio was 0.04 - also not bad; i.e the post-test probality
of not having appendicitis with a neg CT scan with a pre-test probability of
50% would be approx 90%.
BTW - I am hesitant to observe patients overnight rather than progressing
with the work-up if they have had pain more than 8-12 hours.. Those are the
patients that are usually perforated the next morning and the surgeons point
fingers back at us asking why we did not more aggressively pursue the
Have a Happy St. Patrick's Day and don't ever drink green beer without taking
motrin before going to bed.
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