[ RadSafe ] RE: radsafe Digest, Vol 122, Issue 10

[David & Susan McElrath]

> Why are CT scans being used to diagnose
> appendicitis in children?  Why not do white blood cell counts; and
> do what is called "letting up" on the patient's abdomen?  (Those who
> have been "let up" on will know what I mean.)

Leukocytosis and the presence of rebound tenderness is non-specific to
appendicitis. Assessing for rebound tenderness ("letting up") may cause
severe pain and further trauma, especially in pediatric patients. A
diagnosis of appendicitis based solely on leukocytosis and the presence of
rebound tenderness is irresponsible in this day of modern imaging technology
(IMHO). I would imagine this practice would result in a large number of
unnecessary appendectomies.

I prepare patients for CT scans all the time and have yet to have a patient
or family member express any concern whatsoever about the radiation
exposure. Somehow a theoretical increase in the risk of cancer "someday"
pales in comparison to the problem at hand, usually a potentially
life-threatening condition. I understand the concern is over unnecessary CT
scans and exposure of large populations but this simply breaks down and
becomes irrelevant at the individual patient level. They're hurting, they're
sick; someone has to do something. CT sure beats exploratory surgery and all
its associated risks.

-Susan McElrath, RN, BSN, BSHP


--- Steven Dapra <sjd at swcp.com> wrote:

> Nov. 28, 2007
> 
>          According to an Associated Press report,
> the authors of a "Current 
> Concepts" review article on CT scans in the New
> England Journal of Medicine 

>          A few of my own comments:
> 
>          Why are CT scans being used to diagnose
> appendicitis in 
> children?  Why not do white blood cell counts; and
> do what is called 
> "letting up" on the patient's abdomen?  (Those who
> have been "let up" on 
> will know what I mean.)
> 


+++++++++++++++++++
"Courage is what it takes to stand up and speak, Courage is also what it
takes to sit down and listen." -- Sir Winston Churchill

-- John
John Jacobus, MS
Certified Health Physicist
e-mail:  crispy_bird at yahoo.com

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