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O knowledge, where art thou? Evidence and suspected appendicitis
Markus U Boehnert1, Heinz Zimmermann, Aristomenis K Exadaktylos
1Department of Visceral and Transplantation Surgery, University of Bern, Bern, Switzerland.
Journal of Evaluation in Clinical Practice
|April 7, 2010
Summary
Physicians frequently order unnecessary imaging tests for suspected appendicitis, despite existing guidelines. This audit highlights a gap between evidence-based medicine and actual clinical practice in emergency departments.
Area of Science:
- Medical Imaging
- Clinical Audit
- Evidence-Based Medicine
Background:
- Physician adherence to medical guidelines remains a challenge.
- A gap exists between theoretical medical knowledge and practical application.
- Translational research in medical care requires further development.
Purpose of the Study:
- To audit the utilization of abdominal imaging in the emergency department (ED) for suspected appendicitis.
- To assess the frequency and appropriateness of imaging in diagnosing appendicitis.
- To identify discrepancies between established guidelines and clinical practice.
Main Methods:
- Utilized the 'Qualicare' electronic medical record database for data extraction.
- Analyzed imaging frequencies and accuracy over a 5-year period.
- Focused on patients presenting to a university hospital ED with suspected appendicitis.
Main Results:
- Abdominal imaging (X-ray, ultrasound, CT) was frequently ordered for suspected appendicitis.
- A significant number of patients (125/577) underwent multiple imaging procedures.
- 85 out of 125 patients received a combination of imaging modalities.
Conclusions:
- Physician uncertainty regarding surgical indications leads to excessive imaging.
- The reliability of imaging in excluding acute appendicitis is often limited.
- Future efforts should prioritize knowledge translation and guideline implementation over new guideline creation.
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