Pain Over Speed Bumps in Diagnosis of Acute Appendicitis: Diagnostic Accuracy Study
Helen F Ashdown, academic clinical fellow in general practice, Nigel D'Souza, specialist registrar in general surgery, Diallah Karim, foundation trainee, Richard J Stevens, senior medical statistician, Andrew Huang, consultant colorectal and general surgeon, Anthony Harnden, university lecturer in general practice
Abstract
Objective To assess the diagnostic accuracy of pain on travelling over speed bumps for the diagnosis of acute appendicitis.
Design Prospective questionnaire based diagnostic accuracy study.
Setting Secondary care surgical assessment unit at a district general hospital in the UK.
Participants 101 patients aged 17-76 years referred to the on-call surgical team for assessment of possible appendicitis.
Main outcome measures Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios for pain over speed bumps in diagnosing appendicitis, with histological diagnosis of appendicitis as the reference standard.
Results The analysis included 64 participants who had travelled over speed bumps on their journey to hospital. Of these, 34 had a confirmed histological diagnosis of appendicitis, 33 of whom reported increased pain over speed bumps. The sensitivity was 97% (95% confidence interval 85% to 100%), and the specificity was 30% (15% to 49%). The positive predictive value was 61% (47% to 74%), and the negative predictive value was 90% (56% to 100%). The 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.
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. Asking about speed bumps may contribute to clinical assessment and could be useful in telephone assessment of patients.
