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You may have noticed I’m all for robust criticism of under performing health systems. But this really gets my goat...
I’ve got zero knowledge of this case and limited understanding of what political games Prof Warren is playing but, some observations...
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">/ https://www.abc.net.au/news/2021-04-12/girls-appendix-ruptures-after-long-wait-at-wch/100062382">https://www.abc.net.au/news/2021...
I’ve got zero knowledge of this case and limited understanding of what political games Prof Warren is playing but, some observations...
We have to make sure our criticism are based on fact, and that they don’t create some sort of knee jerk and counter productive reaction. Or *unnecessarily* undermine people’s faith in otherwise good quality care https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">/
When the Prof says “there is no doubt that we could identify a point in the course of the waiting in the waiting room when this poor little girl cried out in distress and clearly her appendix ruptured then” he is categorically WRONG. He cannot know that https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">/
There is an extensive literature (which we regularly ask our trainees to review) that shows when appendicitis is diagnosed late at night it is safer (with fewer complications and no change in perforation rates ) to delay surgery between midnight and 8am https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">/
The professor’s scare mongering about negligence and claims in the article the child should have been seen within 10 minutes create an impression that standard of care is straight from GP to operating room which is not true and potentially more dangerous https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">/
As an aside here I will emphasise that I’m not saying it’s ok to leave a child in pain and un-assessed. They of course should be seen, given adequate analgesia. Fluid resuscitation etc. that is the priority this article implies knife to skin is the important metric https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">/
That’s the evidence based answer but for extra detail here’s my opinion (CW yucky words). We treat ALOT of perforated appendicitis and I can tell you that phrase covers a wide range of clinical variation. There isn’t a consistent timeline that predicts how people perforate https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">/
Time course of symptoms often has little link to severity. Some kids can be sick for days and have a barely infected appendix, others can run the school x-country vomit once and have a whole belly full of pus. When we operate if there is a hole in the appendix =perforated https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">/
That can mean nothing, contained - better the next day. A little, some pus around the appendix or in the pelvis - a few days of antibiotics. Or severely unwell with infection throughout the abdomen -5+ days antibiotics and 20% chance of a further procedure being needed. https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">/
Although every case is different and it is speculation EITHER WAY I can tell you based on evidence and experience that 3 hours would not have lead to a change in severity that means the difference between 1-2 days in hospital versus 9 https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">/
So what’s my point? Experts stay in your lane. Don’t speculate or twist cases to fit a political agenda it undermines your credibility. Health reporters -do a bit better. Establish contacts who are SME who can just nudge you in the right direction...https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">/
and finally ED, give pain relief and fluids. They really work. If anybody says you can’t give pain relief before surgical review they need to undergo a robust re-education process!!! End/https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">
