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Does anyone have a literature reference on use of the CRP in the diagnosis of appendicitis?

Thanks much.

Pam



Pamela S. Murphy, MD, FAAP

Mendy's Place, Children's Emergency Center
HonorHealth Deer Valley Medical Center

Lead Physician
Myelomeningocele Planning Clinic
Children's Rehabilitative Services, District Medical Group

On Jun 29, 2017, at 11:47 AM, Dennis Hernandez <[log in to unmask]<mailto:[log in to unmask]>> wrote:

We also follow what Todd is doing at his shop. WBC and CRP - both labs normal but  inconclusive ultrasound generally buys themselves a 24 hour recheck. If either WBC or CRP are elevated and high probability we do CT but without oral contrast. No rapid MRI yet....

Dennis

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Dennis A. Hernandez, MD, MBA, FACEP
Medical Director, Pediatric Emergency Services
Immediate Past Chief, Florida Hospital for Children, Walt Disney Pavilion
Florida Emergency Physicians
Core Faculty, Florida Hospital Emergency Medicine Residency Program
Assistant Professor, University of Central Florida School of Medicine
Assistant Professor, Florida State University School of Medicine
iPhone: 727-798-0147

On Jun 29, 2017, at 12:54 PM, trzim29 <[log in to unmask]<mailto:[log in to unmask]>> wrote:

I get the data on the MRI...But do you have open MRI?Are you not running into issues with getting kids into the MRI machine?Are you sedating these kids?Trying to rap my hands around this one.We have been utilizing non oral contrast ct for quite some time and I cant remember one bad outcome.With saying that, I maybe have done 1 or 2 abdominal CT scans in the past year or two looking for appendicitis and thatcus is only if there is something atypical on the history...History and physical exam with a tincture of wbc and crp for me.Equivocal gets placed in obs or gets timed follow up with pcp or back in the er in some atypical cases.US, I do, but honestly, thinking more and more it is a waste...sort of...
Todd Z


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-------- Original message --------From: Niel Miele <[log in to unmask]<mailto:[log in to unmask]>> Date: 6/29/17  7:25 AM  (GMT-06:00) To: [log in to unmask]<mailto:[log in to unmask]> Subject: Re: not using oral contrast
Easy answer. Emergent MRI approved. :-)
Niel
Rutgers

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On Jun 28, 2017, at 5:23 PM, Mayer, Thom <[log in to unmask]<mailto:[log in to unmask]>> wrote:

Friends,

Don't you wonder what these radiologists would do if it was their kid?

Just a thought...

Best

Thom
Thom Mayer MD

Sent from my iPhone

On Jun 28, 2017, at 9:33 PM, Rick Place <[log in to unmask]<mailto:[log in to unmask]>> wrote:

We have not been able to completely convince the radiologists to abandon
oral contract here. Partially.

We can on males who are above a certain BMI. The feeling is that skinny
people don't have much adipose tissue and stranding might not be seen.

They are reluctant to abandon this in kids.

There is solid adult data supporting this. Is there strong literature
supporting expanding this change to pediatrics?

Rick
Fairfax

On Wed, Jun 28, 2017 at 2:04 PM, Maureen McCollough <
[log in to unmask]<mailto:[log in to unmask]>> wrote:

Hi all,
I am having difficulty getting oral contrast removed from pediatric
patients needing abd/pelvic CT scans in the ED.  I know many institutions
have abandoned it for ED patients both adult and kids.  I work at one place
and am associated with another place that both have abandoned oral
contrast, and another one that hasn't yet.

I am wondering if folks who have protocols that no longer include oral
contrast, address this issue, etc could send them to me off-line.

thanks!!
Maureen McCollough

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