My favorite pearl: A 3-way acute abdominal series is too insensitive to rule-out any major acute causes of abdominal pain with confidence. So stop ordering them routinely. If you are worried about a perforated viscus, order an upright chest x-ray instead -- more accurate and less radiation.
Reference
Panebianco NL, Jahnes K, Mills AM. Imaging and laboratory testing in acute abdominal pain. Emerg Med Clin N Amer . 2011;29(2):175-93. PMID: 21515175
.
The July issue of Annals of Emergency Medicine has a fairly compelling article suggesting that the BHCG discriminatory zones we use may need to be reconsidered.....just FYI (though you have probably already read it!).
ReplyDeleteDr. J
Dr. J - You are so right. The argument is compelling, stating that a cutoff of BHCG at 3,000 still doesn't help you decide whether a patient has an ectopic or IUP, in the setting of an indeterminate ultrasound. I've been hearing about this study a lot since it was done in my dept (UCSF). Will have to rethink the traditional teaching!
ReplyDelete