Imaging in acute appendicitis: What, when, and why?

Debnath, Jyotindu; George, Richard A.; Ravikumar, R.

doi:10.1016/j.mjafi.2016.02.005

Cited by 42 publications

(32 citation statements)

References 63 publications

(58 reference statements)

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“…Nevertheless, we found variations in the indication of ultrasound for some medical conditions, which may not be in line with recent guidelines and recommendations. For instance, the use of ultrasound for the diagnosis of acute appendicitis is not frequent among our surveyed GPs, although it is recommended in recent studies for suspected acute appendicitis in pediatric and adult patients [28,29]. Similarly, a meta-analysis conducted in 2011 reported the superiority of ultrasound to radiography in the detection of pneumothorax [30]; however, our survey findings show that only 35% of GPs utilize it for this purpose.…”

Section: Main Findingsmentioning

confidence: 69%

The use of ultrasound in primary care: Longitudinal billing and cross-sectional survey study in Switzerland

Touhami

Merlo

Hohmann

et al. 2020

Preprint

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Abstract Background Ultrasound imaging is utilized in Swiss primary care; however, little is known regarding the extent to which it is performed. A course in Point-of-Care ultrasound (POCUS) has been recently introduced to promote and improve the utilization of ultrasound. POCUS will offer faster certification compared to previous courses thanks to a limited set of targeted examinations. With this study, we aim to (1) provide an overview of ultrasound use by general practitioners (GPs), and (2) determine how the clinical uses of ultrasound relate to the targeted objectives of POCUS. Methods This is a quantitative study, analyzing fifteen years of billing data from 213 GPs in Central Switzerland and cross-sectional survey data completed by 61 GPs attending 26 certification and refresher courses offered by the Swiss Society of Ultrasound in Medicine (SGUM). Results According to billing data, 49% of the GPs used ultrasound and provided 130,245 exams to 67,180 patients between 2004 and 2018. Over the years, ultrasound use became more frequent among GPs. Male GPs provide more ultrasound exams than female GPs. Patients that are female, ≥65 years, and multi-morbid had more ultrasound exams compared to males, patients <65 years, and those with only one morbidity, respectively. GPs provided a mean of 129 ultrasound exams per physician-year. Abdominal ultrasound comprised almost 69% of all exams. According to survey data, indications covered many organ systems and clinical conditions, with most POCUS indications being among them. Conclusions Utilization of ultrasound is high among general practitioners and covers a wide range of indications. A focus in certification on POCUS might reduce the variety of indications. Keywords: Ultrasound; general practice; primary care; general practitioners; clinical indications; POCUS; ultrasound certification; Switzerland

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Section: Main Findingsmentioning

confidence: 69%

The use of ultrasound in primary care: Longitudinal billing and cross-sectional survey study in Switzerland

Touhami

Merlo

Hohmann

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…12 However, there are several atypical signs for acute appendicitis, with only pain as described above and peritonitis, which requires further investigations such as imaging techniques. 13 Our patient presented with generalized abdominal pain and elevated inflammatory blood tests, but due to his mental impairment, we could neither gather enough details for an appropriate history nor perform imaging investigations, thus the case was labeled as an atypical acute appendicitis. A C-reactive protein level higher than 1 mg/dL is often encountered in acute appendicitis, and if leukocytosis with neutrophilia is present, it could indicate a gangrenous appendicitis at onset.…”

Section: Discussionmentioning

confidence: 96%

Uncommon Differential Diagnosis of Acute Right-sided Abdominal Pain – Case Report

Kwizera

Wagner

et al. 2019

Journal of Interdisciplinary Medicine

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The appendix is a worm-like, blind-ending tube, with its base on the caecum and its tip in multiple locations. Against all odds, it plays a key role in the digestive immune system and appendectomy should therefore be cautiously considered and indicated. We report the case of a 45-year-old male with a known history of Fragile-X syndrome who presented to the emergency department with intense abdominal pain and was suspected of acute appendicitis, after a positive Dieulafoy’s triad was confirmed. The laparoscopic exploration showed no signs of inflammation of the appendix; nonetheless, its removal was carried out. Rising inflammatory laboratory parameters led to a focused identification of a pleural empyema due to a tooth inlay aspiration. Our objective is to emphasize the importance of a thorough anamnesis, even in cases of mentally impaired patients, as well as to highlight a rare differential diagnosis for appendicitis. Acute appendicitis is an emergency condition that requires a thorough assessment and appropriate therapy. Clinical examinations are important, but in this particular case, imaging methods had a much more important role in establishing the right treatment approach. Furthermore, the signs of acute appendicitis are mimicked by several medical conditions including respiratory tract infections.

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“…La apendicitis, a pesar de los años y la introducción de nuevas tecnologías, sigue siento un reto diagnóstico en los servicios de urgencias. El fácil acceso a las imágenes diagnósticas en el servicio de urgencias han modificado gradualmente la forma de hacer diagnóstico de la apendicitis, así como las cirugías innecesarias 3,4 .…”

Section: Discussionunclassified

Diagnóstico de la apendicitis y su variación en el tiempo

et al. 2019

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Background: Technology changed progresively diagnosis of appendicitis, who is a challenge. The aims of our study were to a) Describe the variation of the diagnosis of appendicitis over time and b) Evaluate the rate of negative appendectomies with the use of different diagnostic tools. Methods: Retrospective database review. Description of the variation of the diagnosis of appendicitis in time of 1645 patients in whom an appendectomy was performed in a health institution in Bogota from January 2011 to December 2016. In adition, The rate of negative appendectomy was also evaluated with the use of different diagnostic tools. Results: The number of patients diagnosed by the clinical and ultrasound findings decreased in time, while the diagnosis by tomography increased. The rate of negative appendectomies with clinical evaluation was 14.5%, abdominal ultrasound 75% and tomography 5.3%. The number of appendectomies decreased from 362 to 215 in six years. Discussion: The availability of technology, its easy realization and deliberate use in the emergency room, have gradually transformed the diagnosis of appendicitis, decreasing the number of patients operated and the rate of negative appendectomies. Conclusions: The results of this study suggest that a) the use of tomography has increased in time, decreasing the diagnosis of clinical and ultrasound findings, and b) the number of negative appendectomies was lower with the use of ultrasound and tomography.

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Imaging in acute appendicitis: What, when, and why?

Cited by 42 publications

References 63 publications

The use of ultrasound in primary care: Longitudinal billing and cross-sectional survey study in Switzerland

The use of ultrasound in primary care: Longitudinal billing and cross-sectional survey study in Switzerland

Uncommon Differential Diagnosis of Acute Right-sided Abdominal Pain – Case Report

Diagnóstico de la apendicitis y su variación en el tiempo

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