We are blessed with a skilled radiology department. During the day, the peds
guys are fantastic but even at night, the adult guys do a pretty good job.
I rarely CT anymore. My readings are frequently positive or else "normal
appendix seen". The latter is more common here than reported in the
literature and reflects increasing comfort and skill.
My approach is to pretty much sono everyone (unless I really don't hink I
will get a good sono and the case is equivocal).
Then I combine the results with my pretest probability, a sort of PIOPED
approach to acute appendicitis.
If the case is truly equivocal and they don't report "normal appendix seen"
or if the patient is high probability and the ultrasound is negative, I will
move to CT.
I always include the parents in the decision whether to CT or not. Most will
opt for observation but occasionally a very conservative parent will want
We have no department policy here, but this approach has worked well for me
with the advantage of significantly reducing my patient CT exposure.
On Wed, Apr 14, 2010 at 8:36 AM, John Lee <[log in to unmask]> wrote:
> How many of you are using US for initial imaging for suspected appendicitis
> in kids? If you use US, are you at an academic or community hospital.
> Because US is more proficiency dependent, I am tending to use CT. I
> that there is more proficiency US for appendicitis at academic centers. I
> personally have never actually had a patient with an US that is positive
> appendicitis, but anecdotally a handful with negative/equivocal US and
> positive CT.
> John Lee
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Rick Place, MD
Pediatric Medical Director
Department of Emergency Medicine
Inova Fairfax Hospital for Children
3300 Gallows Road
Falls Church, VA 22042
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