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Oxford primary care researchers awarded prize for showing effectiveness of speed bumps for ruling out possible appendicitis.

EPA
Prof Anthony Harnden (patient), Dr Helen Ashdown (speed bump) and Dr Dalliah Karim (driver) demonstrating the speed bump test at the 25th First Annual Ig Nobel Awards.
We’re really thrilled to have been awarded an Ig Nobel prize for our research. It came completely out of the blue – but as well as providing evidence which will contribute to day-to-day clinical practice, this study was intended to be a fun piece of science. 
- Dr Helen Ashdown, Nuffield Department of Primary Care Health Sciences, University of Oxford.

Research to show a link between pain while travelling over speed bumps and acute appendicitis has been awarded the Ig Nobel Prize for diagnostic medicine.

The international Ig Nobel Prizes honour achievements that make people laugh, and then think. They celebrate the unusual, honour the imaginative and spur people’s interest in science, medicine and technology.

The prize winning research, led by Oxfordshire GP and clinical researcher Helen Ashdown (pictured above) from the University of Oxford’s Nuffield Department of Primary Care Health Sciences, demonstrates the value of questioning patients about pain while travelling over speed bumps to rule out those who do not need their appendix removed (appendectomy).

“Diagnosing appendicitis can sometimes be a real challenge for doctors, and even though several different clinical tests exist, appendicitis can only be fully confirmed by histological examination following surgery,” said Helen Ashdown. “Any tests that can help work out who might need an operation versus those who can safely be discharged home are beneficial.”

In a study of 101 patients referred to Stoke Mandeville Hospital for possible appendicitis, the researchers asked a series of questions about their journey to hospital to find out if they had travelled over a speed bump and whether they experienced increased pain while doing so. Of the 64 patients who had travelled over speed bumps, 54 reported increased pain (they were designated speed bump positive).

97 per cent of the 34 patients who had been positively diagnosed with appendicitis were found to be speed bump positive. However, 21 patients who had not been diagnosed with appendicitis were also speed bump positive. One patient reporting no pain while travelling over a speed bump was given a positive diagnosis of appendicitis.

The study was published in the British Medical Journal in 2012.

“We found that while the speed bump test is highly sensitive to correctly diagnosing appendicitis, speed bump pain is not very specific to appendicitis alone and was sometimes associated with other abdominal problems like an ovarian cyst or, in most cases, no serious problem at all – so the speed bump test is a poor rule-in test for appendicitis.“

“What’s exciting about these results is that they show us quite conclusively that the speed bump test can be used as a strong rule-out test for appendicitis, so it’s highly unlikely for a patient reporting no pain while travelling over a speed bump to then receive a positive diagnosis for the condition.  In fact, in our study the speed bump test was better at ruling out appendicitis than several other commonly used clinical tests currently available.”

Given how this test can help identify those who don’t have appendicitis, the researchers recommend that the speed bump test is incorporated into routine assessment, alongside other clinical features, for possible appendicitis to rule out the condition .

Commenting on the award on behalf of the team, Helen said:

“We’re really thrilled to have been awarded an Ig Nobel prize for our research. It came completely out of the blue – but as well as providing evidence which will contribute to day-to-day clinical practice, this study was intended to be a fun piece of science so it’s wonderful for it to have been recognised in this way.”

In their acceptance speech at the 25th First Annual Ig Nobel Prize Ceremony at Harvard University, the research team performed a parodied appendicitis consultation, reading out the following poem:

Academic:HelenAshdownSpeedbumps
Dear Sir, this is our proudest day
But first of all we'd like to say
We'd never have achieved this perk
Without the other authors' work

And so that no-one else is missed,
We've brought along a thank you list
Our mums and dads, let's not forget,
I hope you're watching on the net
And all our cats and Aunty Jane…

Patient:
Dear God, I've got this awful pain!
I feel like I'm about to die
Farewell, cruel world, I bid you all goodbye

Relative:
Hey Docs, you fools!  Don't hang about
Get over here and help us out!
Just what the hell is wrong with him?
Please tell us, is the outlook grim?

A heart attack? A brain disease?
Or just a case of dodgy knees?
Appendicitis, could it be?

Surgeon:
It could be that, now let me see?

Radiologist:
But how?!  We have no CT scan,
Or Ultrasound, or X-ray man

Academic:
Just read our paper, then you'll know
That speed bumps are the way to show!
Just drive him quickly up a hump
You know, the pain will make him jump

Appendix cases that we sent
Were sensitive at 97 percent
It really is the simplest test
Though specificity's not the best

Poem written by Dr Peter Bell, University of Edinburgh.

Research team:
  • Helen Ashdown, General Practitioner and Clinical Researcher, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
  • Nigel D’Souza, Trainee in General Surgery, Wessex School of Surgery, UK.
  • Diallah Karim, Trainee in General Practice, Kings College NHS Foundation Trust, London, UK.
  • Abdel Kader Allouni, Specialist Registrar in Diagnostics and Interventional Radiology, Oxford University Hospitals NHS Trust, UK.
  • Simon Kreckler, Consultant Vascular Surgeon, Addenbrookes Hospital, Cambridge UK
  • Richard Stevens, Medical Statistician and Deputy Director of the Medical Statistics Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
  • Andrew Huang, Consultant Laparoscopic and Colorectal and General Surgeon, Buckinghamshire Healthcare NHS Trust, UK.
  • Anthony Harnden, Academic Clinical General Practitioner and Professor of Primary Care, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.

Find out more:

Downloadable research fact sheet: How does this research benefit appendicitis patients? 

BMJ talk medicine podcast - Christmas 2012: The Speed bump test

Helen Ashdown interviewed by the Naked Scientists (at 08:49 on the clock)

Improbable Research - The 25th First Annual Ig Nobel Awards

Altmetric score

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


 

What does this research mean?

Find out more about why this research was conducted, the results and what they mean in practice.

Download fact sheet (.pdf)

Watch the award ceremony:

(From 1:20:30)

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