Two CTs for appendicitis?

[kdburton]

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The hospital I did an EM elective at does two abdominal CTs for pts with suspected appendicitis (one with just the PO contrast and one with PO+IV contrast immediately following). Is this the standard protocol for confirming appendicitis with CT?

 

[Osteopathology]

I have never seen that to be the case --- whole lot of extra RADS there for the patient.

 

[f_w]

That is a rather unethical way to 'pad' procedure volume and revenue for the hospital.

There is no medical need to routinely perform a w+wo study on patients with abdominal pain (there is a big role for it in working up liver or renal lesions, but that is not your typical 'r/o appy' case).

 

[colbgw02]

Is it possible that they want to see how far the PO contrast has gone before they give the IV stuff?

That's certainly not the way we do it, but I'm just trying to figure out what they're thinking.

 

[kdburton]

Is it possible that they want to see how far the PO contrast has gone before they give the IV stuff?

That's certainly not the way we do it, but I'm just trying to figure out what they're thinking.

I think I understand what you're saying - they do a quick scout view first, but its not a full abd CT, just to look at the contrast before they do a full abd CT. This I've actually seen quite a bit in the literature I've been looking at... The difference here is that the ER docs were actually ordering two full abd CTs (one with and one without IV contrast). When I asked about it they said that is how they've always done it there, that was also how the radiologists wanted it so they could get a good read (and in the event that it wasn't appendicitis they had a better chance of catching alternative pathology without having to make the pt come to CT again). So it sounds good if you don't know how much radiation exposure comes from an abdominal CT but if they really only need a second CT in 10-20% of the cases, assuming appendicitis was at the top of the DDx, then why would you do two on everyone... One of the attending ER docs there said he was pretty sure that getting one with and without contrast was standard op in most EDs, but I'm having a hard time finding anything that says this. Any more responses?

 

[f_w]

that was also how the radiologists wanted it so they could get a good read (and in the event that it wasn't appendicitis they had a better chance of catching alternative pathology without having to make the pt come to CT again).;

Outside of kidney stones, there is nothing that gives you abdominal pain that requires a non-contrast study first. There will be the occasional 'incidentals' that a non-contrast study allows to resolve. But that is what they are 'occasional' and 'incidental' (hyperdense renal cysts, adrenal adenomata.....).

but if they really only need a second CT in 10-20% of the cases,

In my experience the recall rate is more in the 3-5% range.

why would you do two on everyone...

Because you have an unscrupulous hospital administrator who wishes to pad his procedure numbers and revenue.

he was pretty sure that getting one with and without contrast was standard op in most EDs,

It is not.....