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I recently spoke w one of our peds surgeons about this issue.  He has a Ph.D in engineering and he thinks the issue of radiation exposure for Abd/Pelvic CT is way overblown.  We tend not to do that many US studies so of course when we do get one they never see the appendix.  Are most centers trending towards US evaluation?

 

James Reingold, M.D.

Cardon Children's Hospital

Mesa, AZ
 
> Date: Fri, 16 Apr 2010 02:58:11 -0400
> From: [log in to unmask]
> Subject: Re: appendicitis
> To: [log in to unmask]
> 
> 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 
> [log in to unmask] <mailto:[log in to unmask]> 
> 
> ________________________________
> 
> 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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