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Research explained

Pain over speed bumps in diagnosis of acute appendicitis: diagnostic accuracy study

  • By: Kirsten Patrick
  • Published: 19 December 2012
  • DOI: 10.1136/sbmj.e8347
  • Cite this as: Student BMJ 2012;20:e8347

As noted in a BMJ Easily Missed article published in 2011, acute appendicitis can be difficult to diagnose, particularly when patients don’t present with the classic set of symptoms and signs.1 In fact, the clinical pattern of vague abdominal pain followed by vomiting with migration of the pain to the right iliac fossa, which was first described by Murphy, is present only in about half of patients. Over-zealous surgeons have been known to remove normal appendices, particularly since laparoscopic appendicectomy made this easier to do. Such an approach is less than ideal because surgery is not without hazards. The ideal scenario would be to operate on patients with genuine appendicitis and to leave the rest well alone. Tools can aid diagnosis: scores that sum positive findings from the history, examination, and inflammatory markers. Of these, the appendicitis inflammatory response (AIR) score seems to be the best discriminator.2 But wouldn’t it

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