<< Observiong patients overnight with suspected appendicitis is the rule by
Not a bad decision and very common here - unless classic with elevated WBC
or (+) CT - then right to surgery.
<<We do not keep the patients but rather consult surgery with each
case and they are the ones who decide on whether or not to admit and
observe. Seems we do not agree here.>>
Actually, we do agree - this is good medicine.
We are dealing with surgical residents as the initial consultants most of the
time at teaching institutions..They barely believe it's appendicitis until
they see the path report unless they are scheduled for add-on cases that
night or weekend. If an attending pediatric surgeon or adult surgeon who "is
comfortable" with kids (in quotes because some punt) is my first contact - no
doubt - defer to what they want to do. But beacuse of the inevitable delays
" Call me when the CBC isback" , I am directing more and more work-ups to
But, you have to take into account the next question:
<<Wouldn't the sensitivity of US or CT ne operator dependent?>> Yep. I trust
CT more than residents' interpretations of U/S between 5PM and 7 AM.
Sorry, no slams intended here but it is the patient's health and my
repurtation on the line and we all know whose opinions we trust and those
whose we don't with this very tough clinical challenge.
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