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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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lunes, 20 de julio de 2020

Appendicitis

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emDocs - July 20, 2020 - By Pederson T, Hagahmed M
Reviewed by: Lew E; Koyfman A and Long B
#1: Utilize prediction scoring tools: AIR score for high risk patients, Alvarado score for dischargeable patients.
These tools can reduce cognitive bias by enabling us to work up the disease objectively using the same criteria for every patient, and they are especially useful for prompting further workup for patients classified as intermediate risk. The AIR score has been shown to outperform Alvarado in identifying high risk patients.

#2: Don’t be afraid to utilize CT imaging for intermediate risk patients, including pregnant women and children.
The overwhelming majority of missed appendicitis is in “intermediate risk” patients. While ultrasound is the appropriate first imaging modality to consider in children and pregnant women, it should not be used to rule out appendicitis, as the sensitivity is only 63% (33). In intermediate risk patients who you still have a high suspicion for appendicitis after negative or inconclusive ultrasound, get the CT. You will “rule-in” appendicitis 9 times out of 10.

#3: Train yourself to consider appendicitis in “outlier” populations: children, pregnant women, older adults, and black patients. 
If we wish to decrease the misdiagnosis rate of appendicitis among “all comers” to the emergency department, then we must remain vigilant for the diagnosis in these populations.