Acute appendicitis: influence of early pain relief on the accuracy of clinical and US findings in the decision to operate--a randomized trial - Vermeulen, B.; Morabia, A.; Unger, P. F.; Goehring, C.; Grangier, C.; Skljarov, I.; Terrier, F. (Radiology, 1999)
PURPOSE: To determine the influence of early pain relief on the diagnostic performance of ultrasonography (US) and on the appropriateness of the surgical decision. MATERIALS AND METHODS: A prospective randomized, double-blind placebo-controlled trial with morphine was conducted. A visual analog scale was used to evaluate pain in 340 patients aged 16 years or older. US was performed with a standardized protocol. Diagnosis was confirmed at histologic analysis or, in the patients released without surgery, at follow-up. RESULTS: One hundred seventy-five patients were injected with morphine, and 165 were injected with the placebo. Pain relief was stronger in the morphine group. In the morphine group, US had lower (71.1%) sensitivity (difference, -9.5%; 95% CI, -18.5%, -0.5%) and higher (65.2%) specificity (difference, 11.4%; 95% CI, 1.0%, 21.8%). This group had also a higher positive predictive value (64.6%) and a lower negative predictive value (71.4%), but the differences between this group and the placebo group were not statistically significant. Among female patients, the decision to operate was appropriate more often in the morphine group (75.8%), but the difference between this group and the placebo group was not statistically significant (5.1%; 95% CI, -7.4%, 17.6%). In male patients and overall, opiate analgesia did not influence the appropriateness of the decision. The appropriateness to discharge patients without surgery was 100% in all groups. CONCLUSION: Morphine does not improve US-based diagnosis of appendicitis.
Keywords: journalArticle; *Appendectomy; *Decision Making; Abdominal Pain/*drug therapy; Acute Disease; Adolescent; Adult; Analgesics, Opioid/administration & dosage/therapeutic use; Appendicitis/*diagnostic imaging/surgery; Confidence Intervals; Double-Blind Method; Female; Follow-Up Studies; Humans; Injections, Intravenous; Male; Morphine/administration & dosage/therapeutic use; Pain Measurement; Patient Discharge; Placebos; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity; Sex Factors; Ultrasonography