Skip to main content Accessibility help
×
×
Home

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

  • KyeongWon Kang (a1), Woo Jeong Kim (a1), Kyuseok Kim (a2), You Hwan Jo (a2), Joong Eui Rhee (a2), Jin Hee Lee (a2), Yu-jin Kim (a2), JaeHuk Lee (a2), Sung-Bum Kang (a3), Duck-Woo Kim (a3), Kyung-Ho Lee (a4), Young Hoon Kim (a4) and Hyun Mi Park (a2)...

Abstract

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.

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.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

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

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

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

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

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

Copyright

Corresponding author

Correspondence to: Dr. Woo Jeong Kim, Emergency Medicine Department, Jeju National University Hospital, Aran 13gil Jeju-si, Republic of Korea; kkwpps@hanmail.net

References

Hide All
1.Brown, JJ. Acute appendicitis: the radiologist's role. Radiology 1991;180:1314.
2.Nissman, SA, Kaplan, IJ, Mann, BD. Critically reappraising the literature-driven practice of analgesia administration for acute abdominal pain in the emergency room prior to surgical evaluation. Am J Surg 2003;185:291296, doi:10.1016/ S0002-9610(02)01412-5.
3.Pace, S, Burke, TF. Intravenous morphine for early pain relief in patients with acute abdominal pain. AcadEmergMed 1996;3:10861092, doi:10.1111/j.1553-2712.1996.tb03365.x.
4.Kim, MK, Strait, RT, Sato, TT, et al. A randomized clinical trial of analgesia in children with acute abdominal pain. Acad Emerg Med 2002;9:281287, doi:10.1111/J.1553-2712.2002.tb01319.x.
5.Mahadevan, M, Graff, L. Prospective randomized study of analgesic use for ED patients with right lower quadrant abdominal pain. Am J Emerg Med 2000;18:753756, doi:10. 1053/ajem.2000.16315.
6.Thomas, SH, Silen, W, Cheema, F, et al. Effects of morphine analgesia on diagnostic accuracy in emergency department patients with abdominal pain: a prospective, randomized trial. J Am Coll Surg 2003;196:1831, doi:10.1016/S1072-7515(02)01480-1.
7.Wolfe, JM, Smithline, HA, Phipen, S, et al. Does morphine change the physical examination in patients with acute appendicitis? Am J Emerg Med 2004;22:280285, doi:10.1016/ j.ajem.2004.02.015.
8.Kim, K, Rhee, JE, Lee, CC, et al. Impact ofhelical computed tomography in clinically evident appendicitis. Emerg Med J 2008;25:477481, doi:10.1136/emj.2006.044552.
9.Jo, YH, Kim, K, Rhee, JE, et al. The accuracy of emergency medicine and surgical residents in the diagnosis of acute appendicitis. Am J Emerg Med 2010;28:766770, doi:10.1016/ j.ajem.2009.03.017.
10.Rao, PM, Rhea, JT, Novelline, RA, et al.. Effect of computed tomography ofthe appendix on treatment ofpatients and use of hospital resources. N Engl J Med 1998;338:141146, doi:10.1056/NEJM199801153380301.
11.Ciccone, A, Allegra, JR, Cochrane, DG, et al. Age-related differences in diagnoses within the elderly population. Am J Emerg Med 1998;16:4348, doi:10.1016/S0735-6757 (98)90063-8.
12.McCaig, LF, Burt, CW. National Hospital Ambulatory Medical Care Survey: 2001 emergency department sum-mary. Adv Data 2003, Jun 4 335:129.
13.Zoltie, N, Cust, MP. Analgesia in the acute abdomen. Ann R Coll Surg Engl 1986;68:209210.
14.Tait, IS, Ionescu, MTV, Cuschieri, A. Do patients with acute abdominal pain wait unduly long for analgesia? J R Coll Surg Edinb 1999;44:181184.
15.Manterola, C, Astudillo, P, Losada, H, et al. Analgesia in patients with acute abdominal pain. CochraneDatabaseSyst Rev 2007 3):CD005660.
16.Vane, DW. Efficacy and concerns regarding early analgesia in children with acute abdominal pain. Pediatrics 2005;116:1018doi:10.1542/peds.2005-1430.
17.Armstrong, FD. Analgesia for children with acute abdominal pain: a cautious move to improved pain management. Pediatrics 2005;116:10181019, doi:10.1542/peds.2005-1719.
18.Vermeulen, B, Morabia, A, Unger, PF, et al. Acute appendicitis: influence of early pain relief on the accuracy of clinical and US findings in the decision to operate—a randomized trial. Radiology 1999;210:639643, doi:10.1148/ radiology.210.3.r99fe54639.
19.Flum, DR, Morris, A, Koepsell, T, et al. Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA 2001;286:17481753, doi:10.1001/jama.286. 14.1748.
20.Pickhardt, PJ, Lawrence, EM, Pooler, BD, et al. Diagnostic performance of multidetector computed tomography for suspected acute appendicitis. AnnInternMed 2011;154:789796; W-291 doi:10.7326/0003-4819-154-12-201106210-00006.
21.Green, R, Bulloch, B, Kabani, A, et al. Early analgesia for children with acute abdominal pain. Pediatrics 2005;116:978983, doi:10.1542/peds.2005-0273.
22.Attard, AR, Corlett, MJ, Kidner, NJ, et al. Safetyofearlypain relief for acute abdominal pain. BMJ 1992;305:554556, doi:10.1136/bmj.305.6853.554.
23.Paulson, EK, Kalady, MF, Pappas, TN. Clinical practice. Suspected appendicitis. N Engl J Med 2003;348:236242, doi:10.1056/NEJMcp013351.
24.Abujudeh, HH, Kaewlai, R, McMahon, PM, et al. Abdominopelvic CT increases diagnostic certainty and guides management decisions: a prospective investigation of 584 patients in a large academic medical center. AJR Am J Roentgenol 2011;196:238243, doi:10.2214/AJR.10.4467.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Canadian Journal of Emergency Medicine
  • ISSN: -
  • EISSN: 1481-8035
  • URL: /core/journals/canadian-journal-of-emergency-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed