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Appendicitis: Sensitivity and Specificity

Introduction: RLQ pain

nausea

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Tags: Gastrointestinal Problem Infection Physical Exam Tag this Diagnosis.

Differential Diagnoses include: Urinary Tract Infection

Prevalence

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

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Sensitive and Specific Findings
Finding	Result	Sensitivity	Specificity
[ + ] Abdominal CT	+ 0 -	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	Result	Sensitivity	Specificity
[ + ] Psoas sign	+ 0 -	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	+ 0 -	65%	86%
By CT. In children Study: AJR Am J Roentgenol. 2000 Oct;175(4):981-4. PMID: 11000148

Sensitive Findings
Finding	Result	Sensitivity	Specificity
[ + ] Pain preceeding vomiting	+ 0 -	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	+ 0 -	86%	81%
Study: Ann Intern Med 2004 Oct 5;141(7):537-46. PMID 15466771

Negative Findings
Finding	Result	Sensitivity	Specificity
[ + ] Emesis	+ 0 -	51%	45%
Study: JAMA. 1996;276(19):1589-1594 http://jama.ama-assn.org/cgi/content/abstract/276/19/1589

Findings With Unspecified Accuracy
Finding	Result	Sensitivity	Specificity
[ + ] Obturator sign		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		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.
[ + ] RLQ Pain		No accuracy specified.
Differential Diagnosis: Urinary Tract Infection Study: no study specified.