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Nonoperative management (NOM) for uncomplicated appendicitis has become more common over the past 10 years in the pediatric population. Although many children do well, those who have recurrences have higher rates of surgical complications and hospitalizations.
Source
Nonoperative Management of Uncomplicated Appendicitis. Pediatrics. 2022 Apr 18;e2021054693. doi: 10.1542/peds.2021-054693. Online ahead of print.
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There are few studies that address the overall diagnosis and management of acute left sided colonic diverticulitis; many, over the past 3 decades, have poor strength of evidence or are largely inconclusive.
Source
Diagnostic Imaging and Medical Management of Acute Left-Sided Colonic Diverticulitis : A Systematic Review. Ann Intern Med. 2022 Mar;175(3):379-387. doi: 10.7326/M21-1645. Epub 2022 Jan 18.
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Symptoms and signs of ruptured abdominal aortic aneurysm (rAAA) are frustratingly insensitive. CTA is essential and is accurate. POCUS can accurately tell you a AAA is present but is not meant to diagnose rupture.
Source
Accuracy of Presenting Symptoms, Physical Examination, and Imaging for Diagnosis of Ruptured Abdominal Aortic Aneurysm -Systematic Review and Meta-Analysis. Acad Emerg Med. 2022 Feb 27. doi: 10.1111/acem.14475. Online ahead of print.
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The CODA trial initially found antibiotic treatment was noninferior to surgery for acute appendicitis at 30 days. In this follow up letter on long-term outcomes (up to 4 years), the incidence of appendectomy in the antibiotic group was higher than pooled results from prior trials.
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Point-of-care ultrasound for hypertrophic pyloric stenosis is accurate, can be incorporated into a protocol with radiology-performed ultrasound without delaying treatment, and can reduce ED length of stay.
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This study highlighted the operator dependence of POCUS for the evaluation of acute appendicitis in an undifferentiated emergency department population including both pediatric and adult patients.
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In shared decision making between patient and provider, it is reasonable to consider non-operative treatment of acute uncomplicated appendicitis (lack of appendicolith, abscess, tumor, perforation, sepsis, hemodynamic instability, age <45) as a safe first-line alternative to appendectomy.
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Ultrasound is a valuable tool to evaluate for intussusception by trained emergency physicians.
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CT abdomen and pelvis is associated with a higher incidence of hematologic malignancies over a two year span, especially in younger patients.
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The bilateral anterior clamshell thoracotomy technique was as fast (faster for some) as the left anterolateral thoracotomy, resulted in fewer iatrogenic injuries, and was favored by emergency physicians.
