Improving diagnostic accuracy in appendicitis.
After reviewing all 123 of these patients, here are some suggestions which may improve the accuracy of diagnosis of appendicitis. 1. Proceed slowly with any patient with equivocal history and physical exam +/- WBC less than 10,000. 2. Seriously consider U.T.I. or other renal pathology in patients with greater than 20 RBC +/or greater than 30 WBC/hfp (w/bacteria) as cause of RLQ pain, rather than appendicitis; i.e. only 1 of 81 patients with appendicitis had a coexistent U.T.I. 3. Be aware that pain starting in the RLQ is less common in appendicitis than in other conditions mimicking appendicitis. 4. Be wary of all women presenting with RLQ pain on days 1 through 10 of their menstrual cycle. 5. Consider a barium swallow or enema study in patients in categories 1-4 above looking for a normally filled appendix while a) observing patient and b) awaiting outstanding lab results (i.e. ur. cult., cerv. os cult., etc.). 6. Follow closely all patients in all of the above categories and operate for worsening condition. 7. Require classic or near classic history and physical findings in patients with WBC less 10,000 suspected of having appendicitis, prior to surgery. Footnotes to these suggestions are as follows: 1. Understand that following these suggestions may result in an increase in the incidence of perforation coincident with an increase in diagnostic accuracy. 2. Be less hesitant to operate on patients over 50 y.o. because of a) their frequent atypical presentations, and b) the known higher incidence of perforation in this age group.(ABSTRACT TRUNCATED AT 250 WORDS)
Blalock
J B
JB
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D001466:Barium Sulfate; D002648:Child; D003937:Diagnosis, Differential; D004733:Enema; D005260:Female; D006801:Humans; D007962:Leukocytes / Q000032:analysis; D008297:Male; D008875:Middle Aged
D001466:Barium Sulfate