Give this diagnostic test if appendicitis is suspected

Early acute appendicitis may be difficult to diagnose

The results of a CT scan changed the treatment plan for almost one-third of ED patients with suspected appendicitis, says a new study from the University of Washington Harborview Medical Center in Seattle.1

Sometimes it is difficult to diagnose an early acute appendicitis because the initial lab work might be normal, says Esther Stoltzfus, RN, CEN, assistant nurse manager at Bixler Emergency Center in Tallahassee, FL. Depending on the anatomy of a patient, it also might be difficult to visualize the appendix, she says.

Researchers compared the treatment plans of 100 adult ED patients with symptoms of appendicitis before and after CT, and they found that the plans changed for 29% as a result of the CT findings. In many instances, CT ruled out appendicitis when the treatment plan prior to the scan was surgical consultation. The CT findings, in these cases, eliminated the potential for unnecessary surgery on patients with a normal appendix.

Look for these symptoms, says Katrina Haake, BSN, RN, an ED nurse at Methodist LeBonheur Germantown (TN) Hospital: Pain in the right lower quadrant of the abdomen, fever, nausea, vomiting, and lack of appetite. Signs of appendicitis include a firm abdomen, rebound pain, complaints of increased pain when riding to the hospital and hitting bumps in the road, and the patients feeling better if their knees are drawn up, says Haake. (See Clinical Tip on the "appendix walk," below.)

"Often the pain is lessened when a patient lies still, as I have seen on occasion with pediatric patients," Stoltzfus says.

Appendicitis can be life-threatening when the appendix ruptures and infection sets in, says Stoltzfus. "This would be especially problematic in immuno-compromised or suppressed patients, such as a chemotherapy patient," she says.

Reference

  1. Nathan RO, Blackmore C, Craig J, et al. Therapeutic impact of CT of the appendix in a community hospital emergency department. Amer J Roentg 2008; 191:1,102. DOI: 10.2214/AJR.07.3466.

Clinical Tips

Be on the lookout for the 'appendix walk'

There is a way to recognize the potential for appendicitis before your patient even says a word.

"Triage assessment begins with watching a patient walk in," says Katrina Haake, BSN, RN, an ED nurse at Methodist LeBonheur Germantown (TN) Hospital. "Often, a nurse can spot the 'appendix walk.' The patient is bent over and scuffling to avoid bouncing movement to decrease pain."