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Likelihood Ratio (LR) in Emergency Medicine


How have you come to the hospital?

Clinical Scenario

It’s just started your night shift, Sara is a young EP, she is going home after an hard day.  Hello - she says tired - could you help me? There is a guy with abdominal pain and nausea. I think it could be appendicitis, but there is not fever and not leukocytosis. 

Have you asked if he arrived by car? - You say
No, why? 


Can a speed bump positive test be an effective tool for diagnosis of acute appendicitis?
Compared with classics signs and symptoms of appendicitis a speed bump negative sign performs better. On the other hand a positive test is not specific for acute appendicitis, you can find it also in other conditions like ruptured ovarian cysts or diverticulitis. 

Ambulance and car drivers, take note!!! 


HF Ashdown 
Pain over speed bumps in diagnosis of acute appendicitis: diagnostic accuracy study. 
BMJ 2012; 345:e8012

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

Ciro Paolillo

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