Esparaz et al reported an algorithm for evaluating a pediatric patient in the Emergency Department with suspected appendicitis. The authors are from the University of Illinois and Children's Hospital of Illinois.
Patient selection: pediatric patient from 0 to 17 years of age with suspected appendicitis
Parameters:
(1) right lower quadrant (RLQ) tenderness
(2) WBC count per microliter
RLQ Tenderness
WBC Count
Action
absent
NA
consider alternative diagnosis
present
< 10,000 per µL
observation vs followup outpatient visit next day
present
>= 10,000 per µL
call surgery
Frequency of appendicitis in observation group: 3%
Frequency of appendicitis in action group: 31%
Ultrasound was ordered at the discretion of the surgeon. Ultrasound was found to be more beneficial in females.
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