A study published today in the Christmas edition of the British Medical Journal investigated whether pain on travelling over speed bumps on the journey to hospital could help with the diagnosis of appendicitis.
Appendicitis can sometimes be difficult to diagnose, particularly in the early stages, and doctors have to use a combination of different symptoms, signs and test results to make a decision about whether a patient has appendicitis. Some doctors have routinely asked about pain on travelling over speed bumps to help with the diagnosis, but this was not previously evidence-based.
Dr Helen Ashdown, Academic Clinical Fellow in General Practice in the Department of Primary Care Health Sciences, along with Dr Richard Stevens and Dr Anthony Harnden, worked together with surgeons at Stoke Mandeville Hospital to investigate whether pain over speed bumps is a good test for appendicitis.
Patients who had been referred to hospital with possible appendicitis were given questionnaires which asked about their journey to hospital, including the effect of speed bumps on their pain. Patients were “speed bump positive” if they had worsened pain over speed bumps and “speed bump negative” if their pain got better or stayed the same. The researchers then followed patients through their hospital stay to find out whether they turned out to have appendicitis or not.
The study found that amongst those patients who recalled travelling over speed bumps, 97% of patients with appendicitis were “speed bump positive” on their journey to hospital, and this compared favourably with other more well known features of appendicitis.
The researchers conclude that the absence of pain over speed bumps is a useful tool for excluding appendicitis, but that presence of pain over speed bumps does not guarantee a diagnosis, because many patients who were “speed bump positive” got better without treatment, or had other problems such as a ruptured ovarian cyst. However, asking about speed bumps should form a routine part of assessment of patients with possible appendicitis, to be used along with other clinical features to help make a diagnosis.
Pain over speed bumps in diagnosis of acute appendicitis: diagnostic accuracy study
Ashdown HF, D'Souza N, Huang A, Harnden A
BMJ 2012;345:e8012 doi: http://dx.doi.org/10.1136/bmj.e8012
Helen Ashdown interviewed by the Naked Scientists (at 08:49 on the clock)