I had not looked carefully at the previous few e-mails on this, but there might be the issue here of which statistic one uses.

As TB says, there will be people with bad stuff and normal labs for this condition, as for the vast majority of conditions, especially early on (which is when we see them in the ED, unlike when in the wards). One would say that these labs will have False Negative results when used for the exclusion of significant disease.

I do realise that there are a lot of paedsy people on this List, but I'd like to point out that, in the same way that so many people like to say how children should not be regarded as smaller humans, I can tell you as a "grown up" EP that neither should "adults" be considered a subset of humanity in the same way. In other words, not all humans who are not children are "adults" in terms of our speciality. There are the frail elderly, in many of whom these indices might also come up as false positives through dysfunction of some part of the immune system or their WBCs might be a bit sluggish in responding early on. Don't get me started on the number of elderly men and women with severe sepsis who show no rise in CRP & WBC when we meet them in the ED, while the vast majority of 25-65YOs do. Even among this latter age group, not every patient's immune system gets its numbers right in the early hours of certain inflammation-associated conditions, especially early on and/or in people whose conditions are overwhelming right at the start and/or appear on the background of previous/chronic illness and/or medication...

Finally, I'd like to point out that this is really "good news" in terms of protecting all of our employment prospects - ours is a speciality less likely to be taken over by robots as soon as others will. Radiologists are already in trouble with Google, I hear, with so many companies now working on software which reads imaging. I have personally seen software, written by a friend, which is currently being tested quietly by a number of people, which can correctly analyse any ECG which is of good trace quality. Down to the teensiest detail and in a language which makes sense. And this friend of mine, before you ask, has no medical training at all...

From: Terence Bergmann <[log in to unmask]>
Sent: 10 August 2017 22:51

I can say for sure as a community ER doc for 26 years that these is not a true statements no matter what anyone publishes.  I have seen multiple appy’s, both perf’ed and not yet perf’ed with completely normal labs and also afebrile, with pain easing while being observed in OBS.


On Aug 10, 2017, at 12:23 PM, Zeb Timmons <[log in to unmask]<mailto:[log in to unmask]>> wrote:

one or the other elevated (100% of adults).  100% of patients with complicated appy will have one of the two elevated.

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