Is abdominal pain when asked to hop suggestive of appendicitis in children?
Date First Published:
January 12, 2012
Last Updated:
June 13, 2012
Report by:
Craig McRoberts, CT3 Emergency Medicine (Royal Hospital for Sick Children, Glasgow)
Search checked by:
Dr Vincent Choudhery, Royal Hospital for Sick Children, Glasgow
Three-Part Question:
In [children with suspected appendicitis] how [useful is abdominal pain when asked to hop] at [confirming or refuting the diagnosis]
Clinical Scenario:
A 9 year old presents to the ED with acute abdominal pain; is pain on hopping/jumping indicative of appendicitis?
Search Strategy:
Medline 1946-February week 3 2012 using the OVID interface
Search Details:
{(appendicitis/ OR acute appendicitis/ OR appendicitis.mp) AND (hop.mp OR hopping.mp OR jump$.mp)} NO LIMITS applied
Outcome:
Altogether 6 papers were found, 4 of which were relevant
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| The presentation of appendicitis in preadolescent children. Colvin JM. Bachur R. Kharbanda A. 2007 USA | 379 children 3-12 years of age | Retrospective case note analysis | Appendicitis | Pain on hopping/jumping/coughing present in 67% confirmed cases appendicitis | Study split into 3 separate age groups (3-5.99 years, 6-8.99 years and 9-11.99 years). Only 15 confirmed cases in youngest age group. Criteria offered at hopping/coughing/jumping - no individual breakdown offered |
| Appendicitis | Pain on hopping/coughing/jumping - 89% Sensitivity 66% specificity in 6-8.99 year age group | ||||
| Appendicitis | Pain on hopping/coughing/jumping - 80% Sensitivity 70% specificity in 3-5.99 year age group | ||||
| Appendicitis | Pain on hopping/coughing/jumping - 73% Sensitivity 51% specificity in 9-11.99 year age group | ||||
| Pediatric Appendicitis Score. Samuel M. 2002 UK | 1170 children aged 4-15 | Prospective study of common signs/symptoms looking to create a clinical scoring system for assessing possible appendicitis in children | Pain present on hopping/percussion/coughing | Sens 93%, Spec 100%, Positive Predictive Value 1, Negative Predictive Value 0.88 | Variables in score overlap with other pathology (eg urinary tract infection, gastroenteritis) Narrow proposed score cut-off Applied across wide range of ages High disease prevalence (63% not replicated in subsequent validation studies) |
| Prospective validation of the pediatric appendicitis score. Goldman RD, Carter S, Stephens D, et al. 2008 Canada | 849 children 1-17 | Prospective study, validation of proposals of Samuel | Appendicitis | Cough/percussion/hopping pain present in 72% of confirmed appendicitis 9% of non-appendicitis. Significant p value of<0.01 3rd most common finding in confirmed group after RIF pain (80%) and nausea/vomiting (75%) | Validation study of scoring system proposed by Samuel. Only 2 negative appendectomies Little statistical analysis of individual variables prevalence No analysis of cut-points proposed previously Disease prevalence 14% |
| Prospective validation of the pediatric appendicitis score in a Canadian pediatric emergency department. Bhatt M, Joseph L, Ducharme FM et al. 2009, Canada | 246 children 4-18 | Prospective study, validation of proposals of Samuel | Appendicitis | Score <4 has 97.6% sensitivity and negative predictive value 97.7% and can be discharged<br><br>Score of 8 has 95.1 specificity and positive predictive value 85.2% and should go to theatre<br><br>Scores 5 to 7 diagnosis uncertain and require further imaging for diagnosis. | No analysis of prevalence of components of scoring system. Study looking at sens/spec of total scores<br><br>Disease prevalence 34% |
Author Commentary:
Further validation of a scoring system to aid clinical judgment is required
Bottom Line:
The presence of abdominal pain when asked to hop seems to be both reasonably sensitive and specific to a diagnosis of appendicitis in children.
Level of Evidence:
Level 2: Studies considered were neither 1 or 3
References:
- Colvin JM. Bachur R. Kharbanda A.. The presentation of appendicitis in preadolescent children.
- Samuel M.. Pediatric Appendicitis Score.
- Goldman RD, Carter S, Stephens D, et al.. Prospective validation of the pediatric appendicitis score.
- Bhatt M, Joseph L, Ducharme FM et al.. Prospective validation of the pediatric appendicitis score in a Canadian pediatric emergency department.