EVIDENCE B

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MEDICIN

E SCENARIO

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AGENDA

1- Scenario

2- Background

3- PICO and foreground question.

4- search terms and strategy.

5- visited sites.

6- answers

7- conclusion

SCENARIOA 22-year-old male presents to the emergency

department with abdominal pain, anorexia, nausea, and low-grade fever. Pain started in the mid-abdominal region 6 hours ago and is now in the right lower quadrant of the abdomen. The pain was steady in nature and aggravated by coughing. Physical examination reveals a low-grade fever (38°C; 100.5°F), pain on palpation at right lower quadrant (McBurney's sign), and leukocytosis (12 x 10^9/L or 12,000/microlitre) with 85% neutrophils.

You suspect acute appendicitis and advice the patient to undergo appendectomy but he asks if there is more definitive diagnostic test to diagnose acute appendicitis?

BACKGROUND

What is the diagnostic tests for acute appendicitis and which is suitable for this case?

What is the gold standard for acute appendicitis?

BACKGROUND

- Combination between diagnostic tests and clinical findings is

required for accurate diagnosis of acute appendicitis.

- There is many diagnostic tests including laboratory and

imaging tests.

- 35% of wrong diagnosis for acute appendicitis result in

appendectomy for normal appendix is accepted percent !

- The world search for a definitive diagnostic test for acute

appendicitis and also the patient in my lucky scenario .

BACKGROUND ANSWERS- Gold Standard is exploratory laparotomy

(Histological result from the surgery).- Imaging diagnostic tests is suitable to decrease –

VE appendectomy rates.- One Size doesn't fits all rule . - Our case is for adult non complicated patient

with high Alvarado score ensure high possibility to have acute appendicitis.

- According to our Scenario and background question answers, we choose CT scan test to compare with the gold standard.

PICO

PICO: (Diagnosis)

P: 22 year old male with suspected Acute Appendicitis

I: CT scan on abdomen and pelvic

C: exploratory laparotomy (Histological result from the

surgery).

O: Diagnosis of Acute appendicitis 

FOREGROUND QUESTION

“In adult male with suspected acute appendicitis is CT scan on abdomen and pelvic, as compared with exploratory laparotomy (Histological result from the surgery), will diagnose Acute appendicitis? “

SEARCH TERMS AND STRATEGY

Search terms used alone and/or in combination using

Boolean strategies:

Acute Appendicitis. right lower quadrant pain

Appendectomy McBurney's sign

Diagnostic test Abdominal pain

Computed tomography (CT).

VISITED SITES

1. Cochrane

2. UpToDate

3. Best Practice

4. National Guide lines clearing house

5. Essential evidence plus

6. Dynamed

7. Trip database

8. Sum Search

9. Pubmed

ANSWERS SUMMARY

- Appendicitis may be diagnosed clinically; however, imaging

increases sensitivity and specificity for diagnosis.

- In general, CT is the most accurate imaging study for evaluating

suspected appendicitis and alternative etiologies of right lower

quadrant abdominal pain.

- higher accuracy was reported when IV contrast is used in the CT

scan . However, if IV contrast is contraindicated, non-contrast

enhanced CT has been shown to have sensitivity of 96%,

specificity of 99%, and accuracy of 97%.

CONCLUSION

- There is no unique test for diagnosis of acute appendicitis as we

should combine between clinical and laboratory findings with

imaging test to decrease negative appendectomy rates.

- CT scan has high sensitivity and specificity for evaluating suspected

acute appendicitis .

- CT scan should be used in patients presenting with unclear findings.

- If there is contraindication to contrast media enhanced CT is used.

- Ultrasonography is recommended if CT scan is unavailable or

contraindicated.

THANK YOU FOR YOUR ATTENTION