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Dear John - 
 
In our institution we still attempt to initially obtain US in all our R/O appy patients. We avoid as much as we can unnecessary CT's and especially repeat CT's.
 
We have probably similar numbers on positive, negative and undetermined ("appy not visualized") ultrasound reports. During the day we have Pedi Radiology and Pedi Techs, during night usually Adult Techs and Radiology Residents. Also, we have seen that it is Surgery Attending dependant if they decide to request a CT or not based on clinical picture and correlation with labs, body habitus, male vs. female.
 
For equivocal cases, early presentations, or those in which the suspicion (pre test probability) is relatively high, we push  - usually successfully - for admission to Pedi Surgery for close monitoring, serial abdominal examinations and decision to image as inpatient.
 
Best;
 
Camilo E. Gutiérrez M.D.
Pediatric Emergency Medicine - Boston Medical Center
Assistant Professor of Pediatrics - Boston University School of Medicine
 
ED: 617.414.4991 / Office: 617.414.5514  - 3605  /  Fax:  617.414.4393  /  Pager: 617.638.3605
88 E. Newton St. Vose 5
Boston, MA. 02118                                 
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________________________________

From: Pediatric Emergency Medicine Discussion List on behalf of John Lee
Sent: Wed 4/14/2010 8:36 AM
To: [log in to unmask]
Subject: appendicitis



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 suspect
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 for
appendicitis, but anecdotally a handful with negative/equivocal US and
positive CT.

John Lee

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