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Appendicitis: Sensitivity and Specificity

Introduction: None written.

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Tags: Gastrointestinal Problem Infection Tag this Diagnosis.

Prevalence

Population / CalculatorPrevalence Comments / Study / Link
Adults >60 years old, abdominal pain in the ED 4% http://jama.ama-assn.org/cgi/content/abstract/276/19/1589
Adults, abdominal pain in ambulatory setting 1% http://jama.ama-assn.org/cgi/content/abstract/276/19/1589
Adults <60 years old, abdominal pain in ED 25% http://jama.ama-assn.org/cgi/content/abstract/276/19/1589
More, Edit...

The sensitivity and specificity of findings for Appendicitis are listed below. See the left navigation bar to change the display.

Sensitive and Specific Findings

Finding SensitivitySpecificity Comments, Study
Abdominal CT Edit 94%95%

Usually radiologists like the CTs to be done with rectal contrast. However, there may not be a sensitivity difference between with and without contrast; see PMID: 17456874, PMID: 16105539, though other studies disagree PMID: 17566826.

Study: Ann Intern Med 2004 Oct 5;141(7):537-46. PMID 15466771

Specific Findings

Finding SensitivitySpecificity Comments, Study
Psoas sign Edit 16%95%

With the patient in the supine position, ask the patient to lift the right thigh against your hand placed just above the knee. With the patient in left lateral decubitus position, extend the right leg at the hip.

Study: JAMA. 1996;276(19):1589-1594

http://jama.ama-assn.org/cgi/content/abstract/276/19/1589

Appendicolith Edit 65%86%

By CT. In children

Study: AJR Am J Roentgenol. 2000 Oct;175(4):981-4. PMID: 11000148

Sensitive Findings

Finding SensitivitySpecificity Comments, Study
Pain preceeding vomiting Edit 100%64%

Based on only one study

Study: JAMA. 1996;276(19):1589-1594

http://jama.ama-assn.org/cgi/content/abstract/276/19/1589

Abdominal US Edit 86%81%

Study: Ann Intern Med 2004 Oct 5;141(7):537-46. PMID 15466771

Negative Findings

Finding SensitivitySpecificity Comments, Study
Emesis Edit 51%45%

Study: JAMA. 1996;276(19):1589-1594

http://jama.ama-assn.org/cgi/content/abstract/276/19/1589

Nausea Edit 58%37%

Study: JAMA. 1996;276(19):1589-1594

http://jama.ama-assn.org/cgi/content/abstract/276/19/1589

Poorly Diagnostic Findings

Finding SensitivitySpecificity Comments, Study
Abdominal Rigidity Edit 27%83%

Study: JAMA. 1996;276(19):1589-1594

http://jama.ama-assn.org/cgi/content/abstract/276/19/1589

Migration of Pain Edit 64%82%

Study: JAMA. 1996;276(19):1589-1594

http://jama.ama-assn.org/cgi/content/abstract/276/19/1589

Fever
Duplicate Edit
67%79%

Study: JAMA. 1996;276(19):1589-1594

http://jama.ama-assn.org/cgi/content/abstract/276/19/1589

Rectal tenderness Edit 41%77%

Study: JAMA. 1996;276(19):1589-1594

http://jama.ama-assn.org/cgi/content/abstract/276/19/1589

Rebound Edit 63%69%

Study: JAMA. 1996;276(19):1589-1594

http://jama.ama-assn.org/cgi/content/abstract/276/19/1589

Fever
Duplicate Edit
47%64%

>99F

Study: Acad Emerg Med. 2004 Oct;11(10):1021-7. PMID: 15466143

Guarding Edit 74%57%

Study: JAMA. 1996;276(19):1589-1594

http://jama.ama-assn.org/cgi/content/abstract/276/19/1589

RLQ Pain Edit 81%53%

Study: JAMA. 1996;276(19):1589-1594

http://jama.ama-assn.org/cgi/content/abstract/276/19/1589

Leukocytosis Edit 76%52%

>10k

Study: Acad Emerg Med. 2004 Oct;11(10):1021-7. PMID: 15466143

No similar pain previously Edit 81%41%

Study: JAMA. 1996;276(19):1589-1594

http://jama.ama-assn.org/cgi/content/abstract/276/19/1589

Anorexia Edit 68%36%

Study: JAMA. 1996;276(19):1589-1594

http://jama.ama-assn.org/cgi/content/abstract/276/19/1589

Findings With Unspecified Accuracy

Finding SensitivitySpecificity Comments, Study
Obturator sign Edit No accuracy specified.

Passively flex the right leg at the hip and knee and internally rotate the leg at the hip.

Study: No studies but thought to be equivalent to psoas sign in accuracy.

Rovsing's Sign Edit No accuracy specified.

palpation of the lower left quadrant of a person's abdomen results in more pain in the right lower quadrant

Study: no study specified.