Episode 43 – Appendicitis Controversies
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Apr 22, 2014 Dr. Brian Steinhart, an expert in emergency medicine focused on abdominal emergencies, and Dr. David Dushenski, known for his work in abdominal pain assessment, dive into the controversies surrounding appendicitis. They discuss the nuances of atypical symptoms, the reliability of clinical decision rules like Alvarado and AIR, and the limitations of imaging techniques such as ultrasound versus CT. Controversies around antibiotic use versus surgical intervention for uncomplicated appendicitis are also explored, making for a thought-provoking listen for medical professionals.
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Bumps-On-Road And Urinalysis Clues
- If pain increases with bumps on the drive to the ED, raise your suspicion for appendicitis.
- Do not dismiss positive urinalysis; appendicitis can irritate the ureter and cause pyuria.
Do The Pelvic Exam
- Always perform a pelvic exam in females with lower abdominal pain and send endocervical swabs for GC/chlamydia.
- Do not substitute urine GC/chlamydia testing for a proper pelvic exam.
Decision Scores Often Lag Clinician Gestalt
- Clinical scores like Alvarado and AIR have inconsistent performance and may underperform clinician gestalt.
- These tools might help in test-heavy environments but not where clinicians already use selective imaging.