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Likelihood Ratio (LR) in Emergency Medicine


Acute appendicitis and Symptoms

A 21 y/o man presents to the ED with pain in right low quadrant (RLQ) , anorexia, nausea and vomiting. His abdomen is soft, with a mild tenderness in RLQ, the psoas sign is positive. The pain is aggravate by cough. You perform kindly a rectal examination with pain.  

Are this signs useful for the diagnosis of acute appendicitis?


No clinical signs alone is able to rule in or out an acute appendicitis. Rectal examination, still diffused, is not of any utility. 

May we need somwthing else?


Meta-analysis of the clinical and laboratory diagnosis of appendicitis
British Journal of Surgery 2004; 91: 28-37
R.E.B. Anderson

Ciro Paolillo


  1. The most common and usually first sign of
    is a dull persistent pain on the upper abdomen which turns severe as it progresses on the lower right abdominal area.

  2. thank you for your comment!
    In Literature pain migration, alone. has a poor specificity ( LR+ 2.06: in other words it adds approximately 15% to the pretest probability) and also a poor sensibility (LR-0,5).

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  4. Appendicitis can easily be confused as a normal stomach ailment but its impact is devastating to the extent of one loosing their lives
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