Acute appendicitis
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Speed bumps can aid in the diagnosis of acute appendicitis- Conservative therapy with antibiotics is an option for early uncomplicated acute appendicitis
- In children with acute nonperforated appendicitis, oral antibiotics appear to be inferior to surgery
- Many patients with uncomplicated acute appendicitis do well with antibiotic therapy
- 60% of adults treated with abx for acute appendicitis do not require appendectomy at 5 years
- Oral antibiotics are not equivalent to combination intravenous/oral antibiotics for acute uncomplicated appendicitis
- More than half of adults treated with antibiotics for acute appendicitis do not require appendectomy at 10 years (APPAC)
- One-year outcomes are better in children with acute appendicitis who are initially treated with surgery instead of antibiotics
- New clinical prediction rule (the Pediatric Appendicitis Laboratory Score) accurately rules out appendicitis in children
- Point-of-care ultrasound in the ED is pretty accurate for diagnosis of appendicitis
- 3 clinical features distinguish PID from appendicitis
- Meta-analysis: Antibiotics for appendicitis results in fewer surgeries but more recurrence
- Antibiotics may equal surgery for children with appendicitis
- Quality of life no different after antibiotics vs surgery for appendicitis, but 30% still require surgery in 90 days
- Children with appendicitis do fairly well with antibiotic treatment!
- Decision rule identifies kids at low risk of appendicitis
- Preoperative antibiotics most likely unnecessary while awaiting surgery for uncomplicated appendicitis (PERFECT)
- Ultrasound and CRP (rule out only) are the most useful tools for diagnosing acute diverticulitis that are feasible in primary care
- Ultrasound, followed by CT if negative, best for acute abdomen
- Ubrogepant modestly effective for acute migraine, but safety and a lack of comparison with triptans are concerning