Is "pain before vomiting" useful?: Diagnostic performance of the classic patient history item in acute appendicitis

被引：5

作者：

Takada, Toshihiko ^{[1
,2
]}

Inokuchi, Ryota ^{[3
,4
]}

Kim, Hongja ^{[5
]}

Sasaki, Sho ^{[2
,6
]}

Terada, Kazuhiko ^{[7
]}

Yokota, Hajime ^{[8
]}

Hattori, Shinya ^{[9
]}

Mikami, Wakako ^{[10
]}

Kubota, Tadao ^{[11
]}

Fukuhara, Shunichi ^{[1
,12
]}

机构：

[1] Fukushima Med Univ, Dept Gen Med, Shirakawa Satellite Teaching & Res STAR, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 9610005, Japan

[2] Kyoto Univ, Grad Sch Med, Sch Publ Hlth, Dept Healthcare Epidemiol,Sakyo Ku, Yoshida Konoe Cho, Kyoto 6068501, Japan

[3] JR Tokyo Gen Hosp, Dept Gen & Emergency Med, Shibuya Ku, 2-1-3 Yoyogi, Tokyo 1518528, Japan

[4] Univ Tsukuba, Fac Med, Dept Hlth Serv Res, I-1-1 Tenno Dai, Tsukuba, Ibaraki 3058575, Japan

[5] Kaita Hosp, Dept Gen Practice, 1061-1 Kuchinohara, Iizuka, Fukuoka 8201114, Japan

[6] Iizuka Hosp, Clin Res Support Off, Dept Nephrol, 3-83 Yoshio Machi, Iizuka, Fukuoka 8208505, Japan

[7] Kimitsu Chuo Hosp, Dept Gen Med, 1010 Sakurai, Kisarazu, Chiba 2920822, Japan

[8] Chiba Univ, Grad Sch Med, Dept Diagnost Radiol & Radiat Oncol, 1-8-1 Inohana, Chiba 2608670, Japan

[9] Chiba Univ Hosp, Dept Radiol, 1-8-1 Inohana, Chiba 2608677, Japan

[10] Keiyu Hosp, Dept Radiol, Nishi Ku, 3-7-3 Minatomirai, Yokohama, Kanagawa 2208521, Japan

[11] Tokyo Bay Urayasu Ichikawa Med Ctr, Dept Surg, 3-4-32 Todaijima, Urayasu, Chiba 2790001, Japan

[12] Kyoto Univ, Grad Sch Med, Dept Community Med, Sect Clin Epidemiol, 54 Shogo In Kawaramachi, Kyoto 6068507, Japan

来源：

AMERICAN JOURNAL OF EMERGENCY MEDICINE | 2021年 / 41卷

关键词：

Clinical decision making; Appendicitis; History taking; Alvarado score;

D O I：

10.1016/j.ajem.2020.12.066

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background: In most surgical textbooks, it has been stated that pain almost always precedes vomiting in patients with appendicitis. However, the usefulness of this classic history item, "pain before vomiting", has been investigated in only one study nearly 50 years ago, in which the cause of abdominal pain could not be identified in more than 40% of patients. Accordingly, our objective was to evaluate the performance of pain before vomiting for the diagnosis of acute appendicitis in patients who presented with both acute abdominal pain and vomiting. Methods: A retrospective chart review of adult outpatients with abdominal pain and vomiting at three acute care hospitals was performed. The reference standard for appendicitis was a CT scan evaluated by two radiologists. Diagnostic performance of pain before vomiting and the value it added to the Alvarado score were evaluated. Results: Among 310 patients, 24 patients were diagnosed with appendicitis. Diagnostic performance of pain before vomiting was a sensitivity of 95.8% (95% confidence interval [CI] 79.8-99.3) and a specificity of 16.6% (95% CI 12.6-21.4). When combined with the Alvarado score, it ruled out appendicitis in an additional 12% (increased from 32% to 44%) of patients without any false negatives. Conclusions: "Pain before vomiting" is useful for ruling out appendicitis in patients with abdominal pain and vomiting. (C) 2020 Elsevier Inc. All rights reserved.

引用

页码：84 / 89

页数：6

共 25 条

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