Tag Archives: appendicitis

abdominal pain duration and the accuracy of imaging in pediatric appendicitis

28 Jan

Article by Bachur et al:

The effect of abdominal pain duration on the accuracy of diagnostic imaging for pediatric appendicitis.

duration of abdominal pain is associated with severity of disease (risk of appendiceal perforation generally after 24-48 hrs duration of symptoms)

makes sense that the angrier/more inflamed the appendix gets, the easier it is to see on imaging (particularly ultrasound)

 

HIGHLIGHTS:

1,810 children (age 3-18)

  •  1,216 (68%) assessed by CT
  • 832 (46%) by ultrasonography
  • (238 [13%] had both) 

 

EDITOR’S CAPSULE TAKEAWAY

  • in kids with suspected appy, CT is highly sensitive regardless of symptom duration
  • ultrasound is less sensitive with <48 hrs pain

 

References: Annals article; picture

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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

non-contrast CT for appendicitis

27 Nov

Diagnostic accuracy of noncontrast computed tomography for appendicitis in adults

HIGHLIGHTS:

1258 publications searched, 7 studies met inclusion criteria

1060 patients total included

Pooled data:

  • sensitivity 92.7% (95% CI 89.5-95.0%)
  • specificity 96.1% (95% CI 94.2-97.5%)
  • estimated non-con CT false negative rate: 7.3%
  • range of CT with contrast falst negative rates (from a review): 3-17%

 

BOTTOM LINE:

non-con CT not too shabby for appy.

 

References: article; picture

Appendicitis in children less than 3 years of age

25 Jul
Javed Alloo et al.:
Objectives: 
Discern common symptoms for young pediatric patients
Methods: 
Retrospective review of 28 patients less than three years of age seen by one pediatric surgeon at a childrens hospital in Toronto, ONT.
Results: 
Teaching points: 
Pediatric patients have a wide range of presentation. The inability to tolerate PO and fevers where the most common findings in young children under the age of three
Submitted by W. Rushton.
Reference(s): Javed Alloo et al. “Appendicitis in children less than 3 years of age: a 28-year review” Pediatr Surg Int (2004) 19: 777–779; picture from same article