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Not the greatest article but the only one I find (last literature review on the this specifically 3 years ago)
Lisa Amir
Assist. Chair
Dept. of Emergency Medicine
Schneider Children's Medical Center of Israel

-----Original Message-----
From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Pamela MURPHY
Sent: Thursday, June 29, 2017 10:38 PM
To: [log in to unmask]
Subject: Re: not using oral contrast

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

Sent from my iPhone

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


Sent from my Verizon, Samsung Galaxy smartphone
-------- 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

Sent from my iPhone

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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