Pain over speed bumps in diagnosis of acute appendicitis

22 Jan

that this study (from the BMJ) exists in literature is awesome, in my opinion:


Ashdown HF, et al:

101 patients aged 17-76 years referred to  surgery for possible appendicitis.

64 participants who had traveled over speed bumps on their journey to hospital.

54/64 (total participants) were “speed bump positive.”

 

 

34/64 had a confirmed histological diagnosis of appendicitis

33/34 (with appy diagnosis) reported increased pain over speed bumps.

STATS:

  • sensitivity was 97% (95% confidence interval 85% to 100%),
  • specificity was 30% (15% to 49%)
  • positive predictive value was 61% (47% to 74%),
  • negative predictive value was 90% (56% to 100%).
  • likelihood ratios were 1.4 (1.1 to 1.8) for a positive test result and 0.1 (0.0 to 0.7) for a negative result. 
  • Speed bumps had a better sensitivity and negative likelihood ratio than did other clinical features assessed, including migration of pain and rebound tenderness.

THEIR CONCLUSIONS:

Presence of pain while travelling over speed bumps was associated with an increased likelihood of acute appendicitis.

As a diagnostic variable, it compared favourably with other features commonly used in clinical assessment

OLD POST ON positive likelihood ratios FOR SIGNS/SYMPTOMS OF APPENDICITIS, for those interested.

BOTTOM LINE:

“speed bump sign”

  • good sensitivity
  • bad specificity
  • about as good as our other clinical signs on its own (which is not terribly good)
  • as an isolated finding, take it with a grain of salt, but worth adding to your collection of clinical findings

my two cents: 

  • I sometimes jostle or kick the bed/stretcher of my abdominal pain patients as a sideways eval of peritoneal irritation or abdominal discomfort, so its nice to know there might be some small evidence it could be somewhat useful.

References: bmj article; picture

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