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Effect of pain control in suspected acute appendicitis on the diagnostic accuracy of surgical residents

Published online by Cambridge University Press:  11 February 2015

KyeongWon Kang
Affiliation:
Emergency Medicine Department, Jeju National University Hospital, Jeju-si, Republic of Korea
Woo Jeong Kim*
Affiliation:
Emergency Medicine Department, Jeju National University Hospital, Jeju-si, Republic of Korea
Kyuseok Kim
Affiliation:
Emergency Department, Seoul National University Bundang Hospital, Sungnam-si, Republic of Korea
You Hwan Jo
Affiliation:
Emergency Department, Seoul National University Bundang Hospital, Sungnam-si, Republic of Korea
Joong Eui Rhee
Affiliation:
Emergency Department, Seoul National University Bundang Hospital, Sungnam-si, Republic of Korea
Jin Hee Lee
Affiliation:
Emergency Department, Seoul National University Bundang Hospital, Sungnam-si, Republic of Korea
Yu-jin Kim
Affiliation:
Emergency Department, Seoul National University Bundang Hospital, Sungnam-si, Republic of Korea
JaeHuk Lee
Affiliation:
Emergency Department, Seoul National University Bundang Hospital, Sungnam-si, Republic of Korea
Sung-Bum Kang
Affiliation:
Department of Surgery, Seoul National University Bundang Hospital, Sungnam-si, Republic of Korea
Duck-Woo Kim
Affiliation:
Department of Surgery, Seoul National University Bundang Hospital, Sungnam-si, Republic of Korea
Kyung-Ho Lee
Affiliation:
Department of Radiology, Seoul National University Bundang Hospital, Sungnam-si, Republic of Korea
Young Hoon Kim
Affiliation:
Department of Radiology, Seoul National University Bundang Hospital, Sungnam-si, Republic of Korea
Hyun Mi Park
Affiliation:
Emergency Department, Seoul National University Bundang Hospital, Sungnam-si, Republic of Korea
*
Correspondence to: Dr. Woo Jeong Kim, Emergency Medicine Department, Jeju National University Hospital, Aran 13gil Jeju-si, Republic of Korea; kkwpps@hanmail.net

Abstract

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Objective

To determine the influence of early pain relief for patients with suspected appendicitis on the diagnostic performance of surgical residents.

Methods

A prospective randomized, double-blind, placebo-controlled trial was conducted for patients with suspected appendicitis. The patients were randomized to receive placebo (normal saline intravenous [IV]) infusions over 5 minutes or the study drug (morphine 5 mg IV). All of the clinical evaluations by surgical residents were performed 30 minutes after administration of the study drug or placebo. After obtaining the clinical probability of appendicitis, as determined by the surgical residents, abdominal computed tomography was performed. The primary objective was to compare the influence of IV morphine on the ability of surgical residents to diagnose appendicitis.

Results

A total of 213 patients with suspected appendicitis were enrolled. Of these patients, 107 patients received morphine, and 106 patients received placebo saline. The negative appendectomy percentages in each group were similar (3.8% in the placebo group and 3.2% in the pain control group, p=0.62). The perforation rates in each group were also similar (18.9% in the placebo group and 14.3% in the pain control group, p=0.75). Receiver operating characteristic analysis revealed that the overall diagnostic accuracy in each group was similar (the area under the curve of the placebo group and the pain control group was 0.63 v. 0.61, respectively, p=0.81).

Conclusions

Early pain control in patients with suspected appendicitis does not affect the diagnostic performance of surgical residents.

Résumé

Objectif

L’étude visait à déterminer lˊincidence du soulagement précoce de la douleur chez des patients souffrant vraisemblablement d’appendicite, sur l’efficacité de la pose du diagnostic par les résidents en chirurgie.

Méthode

Un essai comparatif contre placébo, prospectif, à répartition aléatoire et à double insu a été mené chez des patients souffrant vraisemblablement d’appendicite. Ceux-ci ont reçu au hasard soit un placébo (solution physiologique salée intraveineuse [i.v.]) en 5 minutes, soit le médicament à l’étude (morphine, 5 mg, i.v.). Toutes les évaluations cliniques ont été réalisées par les résidents en chirurgie, 30 minutes après l’administration du placébo ou du médicament à l’étude. Après confirmation des probabilités cliniques d’appendicite par les résidents en chirurgie, un examen par tomodensitométrie abdominale a été effectué . L’objectif principal était de comparer l’incidence de l’administration de la morphine, par voie intraveineuse, sur la capacité des résidents en chirurgie à poser le diagnostic d’appendicite.

Résultats

Au total, 213 patients souffrant vraisemblablement d’appendicite ont participé à l’étude. Sur ce nombre, 107 ont reçu de la morphine, et 106, la solution salée placébo. Le pourcentage d’appendicectomie négative était comparable dans chaque groupe (3.8% dans le groupe placébo et 3.2% dans le groupe de soulagement de la douleur; p=0.62). Le taux de perforation était également comparable dans chacun des groupes (18.9% dans le groupe placébo et 14.3% dans le groupe de soulagement de la douleur; p=0.75). L’analyse caractéristique de la performance d’un test a révélé que, dans l’ensemble, l’exactitude diagnostique était comparable dans chaque groupe (la surface sous la courbe dans le groupe placébo et celle dans le groupe de soulagement de la douleur étaient de 0.63 et de 0.61, respectivement; p=0.81).

Conclusion

Le soulagement précoce de la douleur chez les patients souffrant vraisemblablement d’appendicite n’a pas d’incidencesurla pose du diagnostic par les résidentsenchirurgie.

Type
Original Research
Copyright
Copyright © Canadian Association of Emergency Physicians 2014 

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