Abdominal pain in children and the diagnosis of appendicitis

[...]you look for primary studies that compare findings with the standard for the diagnosis: histologically confirmed appendicitis. Reynolds and Jaffe prospectively studied 377 children (aged 2-16 years) seen in an ED with abdominal pain.15 In this study, the presence of two of four findings--vomiti...

Full description

Saved in:
Bibliographic Details
Published inThe Western journal of medicine Vol. 176; no. 2; pp. 104 - 107
Main Authors Paris, Carolyn A, Klein, Eileen J
Format Journal Article
LanguageEnglish
Published United States Copyright 2002 BMJ publishing Group 01.03.2002
BMJ Publishing Group LTD
SeriesEvidence-Based Case Reviews
Subjects
Abdomen
Abdominal Pain - etiology
Appendicitis
Appendicitis - complications
Appendicitis - diagnosis
Appendix
Child
Children & youth
Confidence intervals
Female
Humans
Laboratories
Male
Medical imaging
Mortality
Pain
Studies
Ultrasonic imaging
Vomiting
Online AccessGet full text

Cover

More Information
Summary:[...]you look for primary studies that compare findings with the standard for the diagnosis: histologically confirmed appendicitis. Reynolds and Jaffe prospectively studied 377 children (aged 2-16 years) seen in an ED with abdominal pain.15 In this study, the presence of two of four findings--vomiting, right lower quadrant pain, abdominal tenderness, and abdominal guarding--had a sensitivity of 0.96 and a specificity of 0.72, which produces an LR of 3.4 for two or more of four predictors and an LR of 0.08 for having less than two of these four findings. [...]a patient with only one or none of these predictors is unlikely to have appendicitis.
Bibliography:Competing interests: None declaredThis article was edited by Virginia A Moyer, Department of Pediatrics, University of Texas Health Science Center at Houston. Articles in this series are based on chapters from Moyer VA, Elliott EJ, Davis RL, et al, eds. Evidence-Based Pediatrics and Child Health. London: BMJ Books; 2000.See this article on our web site for the complete list of references.Summary points Pain duration by history should not influence the decision to operate on a patient with abdominal pain, but pain present for a short (<7 hours) or a long duration (>48 hours) is unlikely to be due to appendicitisIn isolation, a history of vomiting does not help make the diagnosis of appendicitis. However, in combination with historical and physical findings (such as right lower quadrant pain or abdominal tenderness or guarding), vomiting may help predict appendicitisRebound tenderness on physical examination may be a useful predictor of appendicitis in a child with a high probability of having acute appendicitis. Furthermore, in a patient with few other findings that suggest appendicitis, a lack of guarding on physical examination may indicate that observation, rather than operation, would be prudentAppendicitis is unlikely to be present when the white blood cell count is low, unless the pretest probability of appendicitis is high. A high white blood cell count for age increases suspicion for acute appendicitis, although whether there is an upper limit is unclearUltrasonography is most helpful for ruling in appendicitis, primarily in patients with equivocal clinical findingsComputed tomography is most helpful in patients who have a nonconclusive ultrasonogram and in whom there is still concern about the diagnosis of appendicitis. No studies have shown it to be clearly superior to ultrasonography
ark:/67375/NVC-SMF85VHZ-H
PMID:11897731
ArticleID:1760104
istex:29F0ABB9089BDE3FF2B421117C25B3D89F067E7E
Correspondence to: Dr Paris cparis@chmc.org
ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-3
content type line 23
ObjectType-Review-1
Summary points Pain duration by history should not influence the decision to operate on a patient with abdominal pain, but pain present for a short (<7 hours) or a long duration (>48 hours) is unlikely to be due to appendicitisIn isolation, a history of vomiting does not help make the diagnosis of appendicitis. However, in combination with historical and physical findings (such as right lower quadrant pain or abdominal tenderness or guarding), vomiting may help predict appendicitisRebound tenderness on physical examination may be a useful predictor of appendicitis in a child with a high probability of having acute appendicitis. Furthermore, in a patient with few other findings that suggest appendicitis, a lack of guarding on physical examination may indicate that observation, rather than operation, would be prudentAppendicitis is unlikely to be present when the white blood cell count is low, unless the pretest probability of appendicitis is high. A high white blood cell count for age increases suspicion for acute appendicitis, although whether there is an upper limit is unclearUltrasonography is most helpful for ruling in appendicitis, primarily in patients with equivocal clinical findingsComputed tomography is most helpful in patients who have a nonconclusive ultrasonogram and in whom there is still concern about the diagnosis of appendicitis. No studies have shown it to be clearly superior to ultrasonography
This article was edited by Virginia A Moyer, Department of Pediatrics, University of Texas Health Science Center at Houston. Articles in this series are based on chapters from Moyer VA, Elliott EJ, Davis RL, et al, eds. Evidence-Based Pediatrics and Child Health. London: BMJ Books; 2000.
Competing interests: None declared
See this article on our web site for the complete list of references.
ISSN:0093-0415
1476-2978