The Value of History-Taking, Physical Examination, and Computer Assistance in the Diagnosis of Acute Appendicitis in Patients More Than 50 Years Old

Eskelinen, Matti; Ikonen, J; Lipponen, P

doi:10.3109/00365529509093289

Cited by 26 publications

(17 citation statements)

References 10 publications

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“…In a large series, 100% of patients with appendicitis, cholecystitis and intestinal obstruction complained of pain followed by vomiting, in contrast with 20 and 24% of patients with nonspecific abdominal pain and gastroenteritis, respectively. Other studies also support this fact and fever and vomiting are more common in patients with acute appendicitis than in those with other causes of acute abdomen (22,23).…”

Section: Discussionsupporting

confidence: 52%

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Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department

Fernandez

López

Montes

et al. 2009

Rev. esp. enferm. dig.

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Objective: to determine the real importance of anamnesis, physical examination, and various tests in the assessment of acute abdominal pain.Methods: a retrospective observational study with patients complaining of abdominal pain at the Emergency Department, Altiplano Health Area (Murcia) was performed. In our study we considered the following variables: socio-demographic data, history of previous surgery, symptoms, place and type of pain. Imaging tests were labeled as positive, negative, or inconclusive for assumed diagnoses, which were retrospectively assessed by an external radiologist who was unaware of the patient's final diagnosis.Results: our study includes 292 patients with a mean age of 45.49 years; 56.8% of these patients were women. Regarding the frequency of the different acute abdomen diagnoses, appendicitis was the main cause (approx. 25%), followed by cholecystitis (10%). We found a significant diagnostic correlation between pain location in the right hypochondrium (RHC) and a diagnosis with cholecystitis. This location was also significant for acute appendicitis (up to 74%). Regarding clinical signs, we only observed a significant correlation between fever and viscera perforation, and between Murphy's sign and cholecystitis. Sensitivity and specificity found in relation to the psoas sign were similar to those seen in other series, 16 and 95% respectively, and slightly lower than the Blumberg or rebound sign, which we found to be around 50 and 23%, respectively.Conclusions: a) anamnesis and physical examination offer limited accuracy when assessing acute abdomen; b) ultrasound scans offer a low diagnostic agreement index for appendicitis; and c) laparoscopy may prove useful for diagnosis, and is also a possible treatment for acute abdominal pain despite its low diagnostic efficiency.

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Section: Discussionsupporting

confidence: 52%

“…Otros trabajos también apoyan este hecho, así, fiebre y los vómitos son más frecuentes con apendicitis aguda que en las otras causas de abdomen agudo (22,23).…”

Section: Discussionunclassified

Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department

Fernandez

López

Montes

et al. 2009

Rev. esp. enferm. dig.

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“…38 Another challenge is the poor memory of many elderly patients, which often makes it difficult to ascertain the initial signs and symptoms and when they began. 39,40 Current management standards for AAP Figure 1 shows the typical management and referral pathways for AAP patients through the UK healthcare system. Substantial changes are likely in the risk of serious causes of AAP as patients move through the healthcare system, with those in the community having the lowest risk of a To GP or hospital?…”

Section: Children and The Elderlymentioning

confidence: 99%

Systematic reviews of clinical decision tools for acute abdominal pain

Liu¹,

Wyatt²,

Deeks³

et al. 2006

Health Technol Assess

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“…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.…”

mentioning

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 Value of History-Taking, Physical Examination, and Computer Assistance in the Diagnosis of Acute Appendicitis in Patients More Than 50 Years Old

Cited by 26 publications

References 10 publications

Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department

Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department

Systematic reviews of clinical decision tools for acute abdominal pain

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

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