Evidence based medicine scenario Example
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Evidence based medicine scenario Example



Evidence based medicine scenario Example for Acute appendicitis diagnosis, show how to formulate answerable clinical question using PICO. ...

Evidence based medicine scenario Example for Acute appendicitis diagnosis, show how to formulate answerable clinical question using PICO.
Note: this presentation is only for learning and general knowledge and you should not use any information mentioned in with out physician consultation.



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    Evidence based medicine scenario Example Evidence based medicine scenario Example Presentation Transcript

    • AGENDA 1- Scenario 2- Background 3- PICO and foreground question. 4- search terms and strategy. 5- visited sites. 6- answers 7- conclusion
    • SCENARIO A 22-year-old male presents to the emergency department with abdominal pain, anorexia, nausea, and low-grade fever. Pain started in the mid-abdominal region 6 hours ago and is now in the right lower quadrant of the abdomen. The pain was steady in nature and aggravated by coughing. Physical examination reveals a low-grade fever (38°C; 100.5°F), pain on palpation at right lower quadrant (McBurney's sign), and leukocytosis (12 x 10^9/L or 12,000/microlitre) with 85% neutrophils. You suspect acute appendicitis and advice the patient to undergo appendectomy but he asks if there is more definitive diagnostic test to diagnose acute appendicitis?
    • BACKGROUND What is the diagnostic tests for acute appendicitis and which is suitable for this case? What is the gold standard for acute appendicitis?
    • BACKGROUND - Combination between diagnostic tests and clinical findings is required for accurate diagnosis of acute appendicitis. - There is many diagnostic tests including laboratory and imaging tests. - 35% of wrong diagnosis for acute appendicitis result in appendectomy for normal appendix is accepted percent ! - The world search for a definitive diagnostic test for acute appendicitis and also the patient in my lucky scenario .
    • BACKGROUND ANSWERS - Gold Standard is exploratory laparotomy (Histological result from the surgery). - Imaging diagnostic tests is suitable to decrease –VE appendectomy rates. - One Size doesn't fits all rule . - Our case is for adult non complicated patient with high Alvarado score ensure high possibility to have acute appendicitis. - According to our Scenario and background question answers, we choose CT scan test to compare with the gold standard.
    • PICO PICO: (Diagnosis) P: 22 year old male with suspected Acute Appendicitis I: CT scan on abdomen and pelvic C: exploratory laparotomy (Histological result from the surgery). O: Diagnosis of Acute appendicitis
    • FOREGROUND QUESTION “In adult male with suspected acute appendicitis is CT scan on abdomen and pelvic, as compared with exploratory laparotomy (Histological result from the surgery), will diagnose Acute appendicitis? “
    • SEARCH TERMS AND STRATEGY Search terms used alone and/or in combination using Boolean strategies: Acute Appendicitis. Appendectomy Diagnostic test right lower quadrant pain McBurney's sign Abdominal pain Computed tomography (CT).
    • VISITED SITES 1. Cochrane 2. UpToDate 3. Best Practice 4. National Guide lines clearing house 5. Essential evidence plus 6. Dynamed 7. Trip database 8. Sum Search 9. Pubmed
    • ANSWERS SUMMARY - Appendicitis may be diagnosed clinically; however, imaging increases sensitivity and specificity for diagnosis. - In general, CT is the most accurate imaging study for evaluating suspected appendicitis and alternative etiologies of right lower quadrant abdominal pain. - higher accuracy was reported when IV contrast is used in the CT scan . However, if IV contrast is contraindicated, non-contrast enhanced CT has been shown to have sensitivity of 96%, specificity of 99%, and accuracy of 97%.
    • CONCLUSION - There is no unique test for diagnosis of acute appendicitis as we should combine between clinical and laboratory findings with imaging test to decrease negative appendectomy rates. - CT scan has high sensitivity and specificity for evaluating suspected acute appendicitis . - CT scan should be used in patients presenting with unclear findings. - If there is contraindication to contrast media enhanced CT is used. - Ultrasonography is recommended if CT scan is unavailable or contraindicated.