How Good Is Gestalt for Predicting Appendicitis in Children and Young Adults?

Experienced emergency physicians' gestalt is best at identifying patients at low risk for appendicitis, although imaging is still ordered for many of these patients.

To determine the accuracy of emergency physician gestalt for acute appendicitis in children, researchers analyzed data from a prospective study of the Pediatric Appendicitis Risk Calculator (pARC) at 11 community emergency departments (NEJM JW Emerg Med Jul 2019 and Ann Emerg Med 2019; 74:471). The analysis included 3426 patients ages 5 to 20 years with right-sided or diffuse abdominal pain for <5 days and 436 attending emergency physicians. Physicians prospectively recorded the likelihood of appendicitis on a sliding scale (1%–10%, 11%–49%, 50%–89%, 90%–100%) based solely on their clinical gestalt before ordering imaging.

Overall, 334 patients (9.8%) had acute appendicitis. Physician gestalt had very good accuracy overall (C-statistic, 0.83…

Reviewing Author

Carolyn K. Holland, MD, MEd, FACEP, FAAP

Disclosures

EquityGeneral Electric

Leadership Positions in Professional SocietiesSociety for Academic Emergency Medicine (Program Committee Chief Resident Forum Subcommittee Chair); American College of Emergency Physicians (Education Committee member)

Carolyn K. Holland, MD, MEd, FACEP, FAAP

Disclosures

EquityGeneral Electric

How Good Is Gestalt for Predicting Appendicitis in Children and Young Adults?

Topics

Reviewing Author