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Diagnostic Modalities in Acute Appendicitis2022

Type: New Practice Management Guideline (PMG)
Category: Emergency General Surgery
Committee Liaison: Asanthi M. Ratnasekera, DO, FACS

Team leader(s)

Acute appendicitis is frequently encountered in emergency general surgery. Despite the high incidence of appendicitis and the recent focus on operative versus non-operative treatment modalities, there is little guidance in which imaging options are best for its diagnosis. Most commonly, the diagnosis of acute appendicitis is made with the combination of clinical exam and CT imaging, but a wide range of options exist, each with possible benefits that should be considered. In select groups, such as in pediatric and obstetric patients, non-ionizing radiation imagining, including includes MRI and ultrasound, are often emphasized but these same studies may have a role in diagnosing acute appendicitis in the average adult patient. This PMG proposal would evaluate the literature assessing diagnostic imaging modalities for acute appendicitis. A literature review has shown a wide breadth of cohort and case control studies that assess the accuracy of CT, MRI, and US. It is the goal of this PMG to compare each imaging approach in general and in special populations to help guide clinicians to obtain the most appropriate study. We feel that a PMG aimed at imaging studies for acute appendicitis could help to minimize unnecessary radiation exposure and increase the likelihood of obtaining timely and accurate diagnosis.

Team members:
• Michael S Farrell, MD, MS
• Tanya Egodage, MD
• Sarah Kolnik, MD, MPH
• Jordan M. Kirsch, DO
• Rondi Gelbard, MD, FACS
• Kurt R. Wharton MD, FACOG
• Phillips Heine, MD

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