> Appendicitis

Appendicitis

Official guideline from the American College of Emergency Physicians.

summary by Eric Steinberg, DO

Recommendations

Risk Stratification

In patients with suspected acute appendicitis, use clinical findings (ie, signs and symptoms) to risk-stratify patients and guide decisions about further testing (eg, no further testing, laboratory tests, and/or imaging studies), and management (eg, discharge, observation, and/or surgical consultation).

Level B

Diagnosis

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

Level B

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

Level B

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

Level B

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, computed tomography (CT) may be performed.

Level C

What do the icons mean?

Level A

Generally accepted principles for patient management that reflect a high degree of clinical certainty (ie, based on strength of evidence Class I or overwhelming evidence from strength of evidence Class II studies that directly address all of the issues).

Level B

Recommendations for patient management that may identify a particular strategy or range of management strategies that reflect moderate clinical certainty (ie, based on strength of evidence Class II studies that directly address the issue, decision analysis that directly addresses the issue, or strong consensus of strength of evidence Class III studies).

Level C

Other strategies for patient management that are based on preliminary, inconclusive, or conflicting evidence, or in the absence of any published literature, based on panel consensus.

Literature

Original/Primary Reference

Howell JM, Eddy OL, Lukens TW, et al. American College of Emergency Physicians. Clinical Policy: Critical Issues in the Evaluation and Management of Emergency Department Patients With Suspected Appendicitis. Ann Emerg Med. 2010;55(1):71-116.

Calc Function

Recommendations