Can going over speed bumps diagnose acute appendicitis?

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The setting was a secondary care surgical assessment unit at a district general hospital in the UK.  101 patients aged between 17 and 76 referred to the on call surgical team for assessment of possible appendicitis, were considered.

The analysis included 64 participants who had travelled over speed bumps on their journey to hospital.  Apparently, 34 had confirmed histological diagnosis of appendicitis, 33 of whom reported increased pain over speed bumps.  It appears that speed bumps had a better sensitivity and negative likelihood ratio than did other clinical features assessed, including migration of pain and rebound tenderness.

The research concluded by suggesting that the presence of pain while travelling over speed bumps was associated with an increased likelihood of acute appendicitis.  As a diagnostic variable it compares with other features commonly used in clinical assessment.  It was felt useful to ask about speed bumps and it was felt this could be useful in telephone assessment of patients.

What an intriguing study!  Is it likely that all hospitals will now need to have speed bumps on the way to A & E so patients can begin their assessment before arriving?  Apparently, potential exists for this test to be incorporated into clinical prediction rules for appendicitis.  This research apparently can have uses in detecting acute abdomen and other conditions as well as potentially ruling our appendicitis as a cause for abdominal pain.

If I had abdominal pain and was being taken to hospital I would want to ensure that we did not go over speed bumps that would add to my pain.

Patricia Wakeford

Associate - Clinical Negligence team

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