Speed bumps could help doctors diagnose appendicitis

A route to hospital involving speed bumps may help doctors confirm a diagnosis in patients with suspected appendicitis, an Oxford University study has found. 

The researchers found that patients whose pain got worse going over speed bumps were more likely to have acute appendicitis. 

Dr Helen Ashdown of the Department of Primary Care Health Sciences at the University of Oxford said: 'It may sound odd, but asking patients whether their pain worsened going over speed bumps on their way in to hospital could help doctors in a diagnosis. It turns out to be as good as many other ways of assessing people with suspected appendicitis.'

Dr Ashdown and colleagues publish their findings in the Christmas issue of the BMJ medical journal.

Clinical diagnosis of acute appendicitis can be difficult and yet it is the most common surgical abdominal emergency. There is no specific clinical diagnostic test for appendicitis, and removing a healthy appendix – which happens often – is best avoided. Similarly, missing appendicitis when it's present can be dangerous.

Researchers from the University of Oxford and Stoke Mandeville Hospital asked 101 adults referred to hospital for suspected appendicitis if their pain worsened while travelling over speed bumps. All participants were questioned within 24 hours of their journey to hospital.

Patients were classed as 'speed bump positive' if speed bumps made their pain worse, or 'speed bump negative' if their pain stayed the same, if they were unsure, or if their pain improved. 

64 patients had travelled over speed bumps on their way to hospital. 54 of these were 'speed bump positive'. 34 of the 64 had a confirmed diagnosis of acute appendicitis, of which 33 – or 97% – had worsened pain over speed bumps. 

Seven patients who were 'speed bump positive' did not have appendicitis but did have other significant problems such as ruptured ovarian cyst or diverticulitis (a digestive condition). 

The accuracy of speed bump pain as a diagnostic indicator compared favourably with other well known signs of appendicitis, the researchers say.

They conclude that an increase in pain over speed bumps is associated with an increased likelihood of acute appendicitis. They add that although being 'speed bump positive' does not guarantee a diagnosis of appendicitis, their findings suggest that it should form a routine part of assessment of patients with possible appendicitis.