A child of 8 years with complaints of pain in the right iliac fossa, a couple of times doubled up from pain on couch, so there is severe pain! On ultrasound in mesogaster rendered more than 3 lymph nodes under 12 mm (mesadenitis?). In the right iliac region is rendered tubular structure 6 mm in diameter, the wall in some places thickened to 2.3 mm, not compressed by probe(rigid), the child says about pain on compression by probe in said projection (enlarged appendix?). After inspecting the surgeon called the ambulance, but ambulance was not ride in the hospital but in one of the research institutes(RI), from which the patient quickly sent back with the unflattering characteristics to doctors which called the ambulance. In particular, they sent to me through parents that the vermiform appendix of 6 mm, and I quote - " it' s about nothing." What is rather strange because it is an internationally recognized criteria for ultrasound acute appendicitis. As I said to the angry parents, after I shown them a page from the book of Rumack, probably our RI is cooler than western experts. By the way parents begged to hospitalize a child with acute abdominal pain but received a reply, and I quote - " We do not treat, we perform surgery" . It was decided to re-send the child with ambulance with a recommendation to the ambulance' s brigade at this time to hospitalize to a normal hospital, which treated. PS. Let' s talk about " nothing" : " Diameters in the symptomatic patients without acute appendicitis ranged between 2 and 11 mm, and 57 (32%) of 180 patients had diameters of 6 mm or more. Diameters of acutely inflamed appendices ranged between 6 and 30 mm... CONCLUSION: The outer appendiceal diameter of 6 mm or more as a sign of acute appendicitis provides high sensitivity but limited specificity. This diagnostic criterion is more useful in excluding acute appendicitis than in confirming it." external link And else, if you please: " The median outer appendiceal diameter was significantly higher in the surgical group compared to the nonsurgical group (9.4 mm; range = 8.1-12.0 vs. 5.5 mm; range = 4.4-6.5 ...The optimal cut-point with the greatest area under the ROC curve was determined to be an outer appendiceal diameter of 7.0 mm. CONCLUSIONS: In our patients, adopting a 7-mm rather than a 6-mm appendiceal diameter threshold would balance a greater number of missed cases of acute appendicitis for a reduction in the number of unnecessary surgeries." external link I.e. conversation about " nothing" has its price and the price is the someone' s life. Statistics it' s good, but not in medicine. Here are the people, not a bolts. (To talk about the average patients temperature in the hospital, etc.) As I understand it, the doctor from the RI has made its conclusion on the basis of express lab blood test where leukocytes were indicated 4.5. Well, excuse me, there is almost nowhere in the Moscow ambulatory clinics express laboratories, honestly I met it only once, ie this is not a rule, but an exception! Besides, leukocytosis is not a gold standard for the diagnosis of appendicitis! " Out of 233 appendicectomies, with exclusion of the negative appendicectomies (17.59%, n = 41), there were 67.38% patients (n = 157) with elevated leukocyte count." external link I.e. 18%(35 of 192) of patients with appendicitis confirmed on surgery(the gold standard of diagnosis!) haven' t leukocytosis! Colleagues, leukocytosis is only a part of the diagnostic algorithm! That' s all! I think there should ponder over the following - we' re still the doctors, for whom the most important thing is to help the patient or we' re the clerks, who decide under the scheme with the best balance of " debit & credit" (the lowest percentage of unnecessary surgical procedures), rather than treated? I.e. will we miss the appendicitis to not spoil the statistics? | 
