Contributions of History-Taking, Physical Examination, and Computer Assistance to Diagnosis of Acute Small-Bowel Obstruction: A Prospective Study of 1333 Patients with Acute Abdominal Pain

Eskelinen, Matti; Ikonen, J; Lipponen, P

doi:10.3109/00365529409092499

Cited by 54 publications

(32 citation statements)

References 8 publications

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“…also reported the sensitivity and specificity of rebound tenderness as 0.91 and 0.80, tenderness in the rightlower quadrant as 0.95 and 0.70, pain in the right-lower quadrant at presentation as 0.94 and 0.70, onset of pain in the rightlower quadrant as 0.88 and 0.75, rigidity as 0.84 and 0.95, and guarding as 0.87 and 0.76. In another report, Eskelien et al 7 ) . found that the most efficient symptoms in diagnosis of acute small-bowel obstruction were previous abdominal surgery (RR=12.1) and type of pain (colic/intermittent versus steady) (RR=2.4).…”

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confidence: 99%

The Relationship Between Abdominal Pain Regions and Specific Diseases: An Epidemiologic Approach to Clinical Practice

Yamamoto

Kono

Maekawa

et al. 1997

Journal of Epidemiology

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In order to evaluate the relationship between the patient-identified regions of abdominal pain and the disease diagnosis, a prospective study was conducted at General Medicine Outpatient Clinic, Saga Medical School Hospital.Four hundred eighty-nine outpatients complaining of abdominal pain at the first visit were classified into 10 groups according to the pain region complained of, i.e., whole abdominal, epigastric, right subcostal, left subcostal, right flank, left flank, periumbilical, right-lower, mid-lower, and left-lower; the clinic physicians and authors in joint-participation assigned the groups through studying the medical records. Comparisons were made in order to calculate sensitivity, specificity, and the positive and negative likelihood ratios between the pain regions and disease diagnoses.In general, the sensitivity of history-taking and physical examination is low, but specificity is high in relation to epigastric pain and gastroduodenal diseases, right subcostal pain and hepatobiliary diseases, and mid lower pain and gynecological diseases (above 0.5).Comparative analysis between the pain regions complained of by the patient in the initial clinic visit and the medical diagnoses yielded clinically useful information as to the efficacy of medical history-taking and physical examination in the identification of abdominal diseases. J Epidemiol, 1997 ; 7 : 27-32. abdominal pain, diagnosis, sensitivity, specificityUnlike imaging techniques such as ultrasonography, radionuclide scanning, and computed tomography, the value of history taking and physical examination, which are not infrequently most important part of diagnostic process, has been rarely evaluated by scientific methods. Recently, however, some researchers have made use of epidemiological methods in evaluating these basic clinical skills in clinical practice '-4) Regarding abdominal pain, textbooks describe that pain in certain abdominal regions ensue in a given certain disease state. However, there are few reports that indicate precisely how we can determine the diseased organ by identifying the pain region. Eskelien et al 5). reported that the most significant predictors of acute appendicitis in patients older than 50 years of age were tenderness (relative risk (RR) = 39.4), rigidity (RR = 18.8), and pain at diagnosis (RR = 11.0). The sensitivity of the preoperative clinical decision in detecting acute appendicitis in the elderly patients was 0.87, with a specificity of 0.92. found that the most efficient symptoms in diagnosis of acute small-bowel obstruction were previous abdominal surgery (RR=12.1) and type of pain (colic/intermittent versus steady) (RR=2.4). On the other hand, Malone et al 8). reported that the unenhanced computed tomography (CT) had a sensitivity of 0.87 and a specificity of 0.97 for the initial examination of patients with suspected acute appendicitis. That is the accuracy of unenhanced CT was mostly the same as that of rigidity of pain in the right-lower quadrant in detecting acute appendicitis. Davies et al 9). ...

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The Relationship Between Abdominal Pain Regions and Specific Diseases: An Epidemiologic Approach to Clinical Practice

Yamamoto

Kono

Maekawa

et al. 1997

Journal of Epidemiology

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“…In Finland, we have studied acute abdominal pain in connection with the survey of acute abdominal pain by the Research Committee of the World Organization of Gastroenterology (OMGE) [1, 2]. Recently, we have described the high accuracy of history-taking and clinical examination in the clinical diagnosis of acute appendicitis, acute cholecystitis and acute small bowel obstruction [3, 4, 5, 6]. …”

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confidence: 99%

Usefulness of History-Taking, Physical Examination and Diagnostic Scoring in Acute Renal Colic

Eskelinen¹,

Ikonen²,

Lipponen³

1998

European Urology

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“…7 A randomized controlled trial of over 1300 patients with acute abdominal pain in Finland indicated that the presence of previous surgery (relative risk 12.1) and the type of pain (colicky versus constant; relative risk 2.4) were the most predictive features in the diagnosis of acute small bowel obstruction. 8 In our study, the most frequent physical finding was the presence of exaggerated bowel sounds (60.3%). Seven (11.1%) patients had no abnormal physical finding.…”

Section: Discussionmentioning

confidence: 95%

Subacute intestinal obstruction: an enigma revisited

Jain¹,

Agrawal²,

Rathi

et al. 2013

Trop Doct

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Sixty-three patients presenting with subacute intestinal obstruction (SAIO) were studied. Thirty (47.6%) reported recurrent symptoms. Exaggerated bowel sound, visible/palpable bowel loops, distention of abdomen and abdominal lumps were observed in 60.3%, 28.5%, 25.3% and 19.0% patients, respectively. Thirty (47.6%) required emergency laparotomy. Investigations revealed lesions requiring surgery in 14 of 33 patients which were relieved with conservative treatment. The accuracy of ultrasonography, contrast enhanced computed tomography (CECT) scan and diagnostic laparoscopy was 57.1%, 100% and 100%, respectively. Ileum was the most common site of obstruction (79.5%). Adhesions and small intestinal strictures were the two most frequent cause of obstruction seen in 31.8% and 27.2%, respectively. Tuberculous pathology was demonstrated in 23 (52.2%). Previous abdominal surgery was found to be the only predictor of the success of conservative treatment (13/19 versus 7/44). All patients of SAIO, whose symptoms were relieved with conservative treatment, and who do not have history of abdominal surgery, should be subjected to CECT and/or diagnostic laparoscopy in order to discover the underlying cause of the obstruction. When these diagnostic modalities are not available, laparotomy is an effective alternative for this group of patients.

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Contributions of History-Taking, Physical Examination, and Computer Assistance to Diagnosis of Acute Small-Bowel Obstruction: A Prospective Study of 1333 Patients with Acute Abdominal Pain

Cited by 54 publications

References 8 publications

The Relationship Between Abdominal Pain Regions and Specific Diseases: An Epidemiologic Approach to Clinical Practice

The Relationship Between Abdominal Pain Regions and Specific Diseases: An Epidemiologic Approach to Clinical Practice

Usefulness of History-Taking, Physical Examination and Diagnostic Scoring in Acute Renal Colic

Subacute intestinal obstruction: an enigma revisited

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