General medicine/clinical policy
Clinical Policy: Critical Issues in the Evaluation and Management of Emergency Department Patients With Suspected Appendicitis

https://doi.org/10.1016/j.annemergmed.2009.10.004Get rights and content

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Abstract

This clinical policy from the American College of Emergency Physicians is an update of a 2000 clinical policy on the evaluation and management of patients presenting with nontraumatic acute abdominal pain.1 A writing subcommittee reviewed the literature to derive evidence-based recommendations to help clinicians answer the following critical questions: (1) Can clinical findings be used to guide decisionmaking in the risk stratification of patients with possible appendicitis? (2) In adult

Methodology

This clinical policy was created after careful review and critical analysis of the medical literature. Multiple searches of MEDLINE and the Cochrane database were performed. Specific key words/phrases used in the searches are identified under each critical question. To update the 2000 American College of Emergency Physicians (ACEP) policy, all searches were limited to English-language sources, human studies, and to articles published from January 2000 to March 2007. Additional articles were

Critical Questions

1. Can clinical findings be used to guide decisionmaking in the risk stratification of patients with possible appendicitis?

Level A recommendations

None specified.

Level B recommendations

In adult patients undergoing a CT scan for suspected appendicitis, perform abdominal and pelvic CT scan with or without contrast (intravenous [IV], oral, or rectal). The addition of IV and oral contrast may increase the sensitivity of the CT scan for the diagnosis of appendicitis.

Level C recommendations

None specified.

Key words/phrases for literature searches: appendicitis, computed tomography, contrast, diagnosis, sensitivity, specificity, and variations and combinations of the key words/phrases.

Level A recommendations

None specified.

Level B recommendations

  • 1

    In children, use ultrasound to confirm acute appendicitis but not to definitively exclude acute appendicitis.

  • 2

    In children, use an abdominal and pelvic CT to confirm or exclude acute appendicitis.

Level C recommendations

Given the concern over exposing children to ionizing radiation, consider using ultrasound as the initial imaging modality. In cases in which the diagnosis remains uncertain after ultrasound, CT may be performed.

Key words/phrases for literature searches: children, appendicitis, computed

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