I believe it is Dr. Rory Spiegel who is asking the wrong questions. (Myths in Emergency Medicine: “A Surgical Emergency No More,” w 2015;37:17; http://emn.online/Dec15Myths.) Faced with a diagnosis of appendicitis, the correct question is, “Do I want to apply a treatment that is 99.6 percent effective, or do I want to apply one that is only 72.7 percent effective?”
It might be that only 27 percent of the patients require an appendectomy, but the problem lies with knowing who is in that 27 percent.
Treating and discharging patients with the knowledge that 27 percent will have to return, when an extremely low-risk treat ment is available that is 100 percent curable, is not the way to go.
Do it right the first time.
John Dente, MD