ACR Appropriateness Criteria® Right Lower Quadrant Pain—Suspected Appendicitis

Rosen, Max P.; Ding, Alexander; Blake, Michael A.; Baker, Mark E.; Cash, Brooks D.; Fidler, Jeff L.; Grant, Thomas; Greene, Frederick L.; Jones, Bronwyn; Katz, Douglas S.; Lalani, Tasneem; Miller, Frank H.; Small, William; Spottswood, Stephanie E.; Sudakoff, Gary S.; Tülchinsky, Mark; Warshauer, David M.; Yee, Judy; Coley, Brian D.

doi:10.1016/j.jacr.2011.07.010

Cited by 186 publications

(81 citation statements)

References 51 publications

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“…Acute appendicitis (AA) is the most common surgical emergency making appendectomy the commonest emergency operation performed worldwide [1][2][3]. It also probably is the first abdominal surgery a resident performs during his surgical training.…”

Section: Introductionmentioning

confidence: 99%

“…Various scoring systems, biochemical markers, and imaging modalities have been introduced to substantiate the diagnosis of AA and thereby decrease NAR. However, there is continuing controversy regarding their availability, cost, validity, and routine use [1,9,10]. A number of studies have been conducted in the West to audit and decrease NAR, but there is paucity of similar studies from the developing world.…”

Section: Introductionmentioning

confidence: 99%

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Negative Appendectomy: an Audit of Resident-Performed Surgery. How Can Its Incidence Be Minimized?

Joshi

Alam

et al. 2014

Indian J Surg

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Negative appendectomy remains a concern in current surgical practice. Data from the developing world is scarce. Data of appendectomies during the last 5 years were analyzed. Interval and incidental appendectomies were excluded. The demographic details, presenting complaints, clinical signs, and investigations performed were recorded in a predesigned proforma. The data were critically analyzed. Six hundred eighty-five appendectomies were performed during the period. One hundred eighty-five patients with a normal appendix were identified on histopathology. Sixty-seven patients with incidental or interval appendectomies were excluded. Thus, 118 patients had appendectomies performed erroneously. All these patients with presumed diagnosis of acute appendicitis were operated on by resident surgeons. Records of 17 patients could not be retrieved. The most common symptom was abdominal pain (100 %), and the commonest sign was right iliac fossa tenderness (93 %). Most of the patients underwent USG to supplement the diagnosis. CT scan and diagnostic laparoscopy were not performed. The negative appendectomy rate was 17.2 % (12.4 % in males; 33.3 % in females). The highest incidence of negative appendectomy was in females aged 11-20 years (66.7 %). The rate of negative appendectomy at our institute is comparable with the world statistics. More diligence is required in making the clinical diagnosis of acute appendicitis, especially in young females. The use of C-reactive protein and CT scan may decrease the negative appendectomy rate.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Negative Appendectomy: an Audit of Resident-Performed Surgery. How Can Its Incidence Be Minimized?

Joshi

Alam

et al. 2014

Indian J Surg

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“…The remaining half of the APR-DRGs were associated with a decrease in CT that exceeded increases in ultrasound/ MRI, suggesting that it was not only a desire to avoid ionizing radiation that drove the decision to not use CT, but a general decline in imaging volume. 39 Other factors also may be at play, such as new or updated national guidelines discouraging routine use of CT for simple febrile or first nonfebrile seizure, 40,41 or the growing use of imaging appropriateness criteria [42][43][44][45][46] and clinical pathways in emergency department and inpatient settings that provide guidance and evidence base for the use or nonuse of certain diagnostic approaches.…”

Section: Figurementioning

confidence: 99%

Computed Tomography and Shifts to Alternate Imaging Modalities in Hospitalized Children

et al. 2015

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Many studies have demonstrated a rise in computed tomography (CT) utilization in children's hospitals. However, CT utilization may be declining, perhaps due to awareness of potential hazards of pediatric ionizing radiation, such as increased risk of malignancy. The objective is to assess the trend in CT utilization in hospitalized children at freestanding children's hospitals from 2004 to 2012 and we hypothesize decreases are associated with shifts to alternate imaging modalities.

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“…Multiple studies have shown that ultrasound performed by an experienced operator is only slightly less sensitive and nearly as specific as CT for the evaluation of appendicitis. Many children's hospitals now perform ultrasound as the initial test for the evaluation of right lower quadrant pain, followed by CT in cases with equivocal results [2]. Using a protocol of ultrasound alone (in cases when there is low pretest probability) or ultrasound followed by CT (in cases with intermediate or high pretest probability) has also been shown to be the most cost-effective approach [3], a consideration that is of increasing importance in today's medical environment.…”

Section: Brent a Townsendmentioning

confidence: 99%

Ultrasound as an Alternative to Computed Tomography for Pediatric Imaging

Townsend

2014

North Carolina Medical Journal

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ACR Appropriateness Criteria® Right Lower Quadrant Pain—Suspected Appendicitis

Cited by 186 publications

References 51 publications

Negative Appendectomy: an Audit of Resident-Performed Surgery. How Can Its Incidence Be Minimized?

Negative Appendectomy: an Audit of Resident-Performed Surgery. How Can Its Incidence Be Minimized?

Computed Tomography and Shifts to Alternate Imaging Modalities in Hospitalized Children

Ultrasound as an Alternative to Computed Tomography for Pediatric Imaging

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