Letter to the Editor

Response to Diagnosis of Appendicitis

Authors: Gerald N. Weiss, MD

Abstract

The article by Mathis et al1 in SMJ in December 2005 reports 150 cases seen by emergency department physicians with a “discharge diagnosis of appendicitis.” Flaws in their study serve to negate the conclusions drawn. They acknowledge that the retrospective study had a bias associated with a higher complication rate occurring when the NCT (no CT) patients were taken to surgery sooner than those having a CT that were less ill. The study also failed to specify if a surgeon was involved in the decision to order a CT scan. Furthermore, they commented upon the “inherent limitations” of their study when relying on chart documentation. The ordering of in-house radiological tests by hospital-affiliated attending physicians, such as in the ER, is a further unnoted bias consideration.

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References

1. Mathis RD, Chiumento AB, Yeh B, et al. An outcome study of the use of computed tomography for the diagnosis of appendicitis in a community-based emergency department. South Med J2005;98:1169–1172.
 
2. Weiss GN. The changing picture in appendiceal disease: a fifteen year survey at Touro Infirmary. New Orleans Med Surg J 1950;102:542–549.
 
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8. Naoum JJ. Do all patients with suspected appendicitis benefit from CT imaging in community-based emergency departments? South Med J 2005;98:1157–1158.
 
9. Liang MK. The art and science of diagnosing acute appendicitis. South Med J 2005;98:1159–1160.