Can The ‘Speed Bump Sign’ Be a Diagnostic Tool for Acute Appendicitis? Evidence-Based Appraisal by Meta-Analysis and GRADE
Objectives: The ‘speed bump sign’ is a clinical symptom characterised by aggravated abdominal pain while driving over speed bumps. This study aimed to perform a diagnostic meta-analysis, rate the certainty of evidence (CoE) and analyse the applicability of the speed bump sign in the diagnosis of acu...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-01-01
|
| Series: | Life |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-1729/12/2/138 |
| _version_ | 1797478704635445248 |
|---|---|
| author | Ling Wang Ching-Hsien Ling Pei-Chun Lai Yen-Ta Huang |
| author_facet | Ling Wang Ching-Hsien Ling Pei-Chun Lai Yen-Ta Huang |
| author_sort | Ling Wang |
| collection | DOAJ |
| description | Objectives: The ‘speed bump sign’ is a clinical symptom characterised by aggravated abdominal pain while driving over speed bumps. This study aimed to perform a diagnostic meta-analysis, rate the certainty of evidence (CoE) and analyse the applicability of the speed bump sign in the diagnosis of acute appendicitis. Materials and Methods: Four databanks and websites were systemically searched, and the Quality Assessment of Diagnostic Accuracy Studies 2 was used to evaluate the risk of bias. Meta-analysis was assessed by MIDAS commands in Stata 15. Grading of Recommendations, Assessment, Development and Evaluation methodology was applied to examine the CoE. Results: Four studies with 343 participants were included. The pooled sensitivity and specificity were 0.94 (95% CI (confidence interval) = 0.83–0.98; I<sup>2</sup> = 79%) and 0.49 (95% CI = 0.33–0.66; I<sup>2</sup> = 67%), respectively. The area under the summary receiver operating characteristic curve was 0.78 (95% CI = 0.74–0.81). The diagnostic odds ratio was 14.1 (95% CI = 3.6–55.7). The pooled positive and negative likelihood ratios (LR (+) and LR (−)) were 1.84 (95% CI = 1.30–2.61) and 0.13 (95% CI = 0.04–0.41), respectively. According to Fagan’s nomogram plot, when the pretest probabilities were 25%, 50% and 75%, the related posttest probabilities increased to 38%, 65% and 85% calculated through LR (+), respectively, and the posttest probabilities were 4%, 12% and 28% calculated through LR (−), respectively. The overall CoEs were low and very low in sensitivity and specificity, respectively. Conclusion: Current evidence shows that the speed bump sign is a useful ‘rule-out’ test for diagnosing acute appendicitis. With good accessibility, the speed bump sign may be added as a routine part of taking the history of patients with abdominal pain. |
| first_indexed | 2024-03-09T21:35:24Z |
| format | Article |
| id | doaj.art-70c8b67fe7b44e94af6a1888f913842e |
| institution | Directory Open Access Journal |
| issn | 2075-1729 |
| language | English |
| last_indexed | 2024-03-09T21:35:24Z |
| publishDate | 2022-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Life |
| spelling | doaj.art-70c8b67fe7b44e94af6a1888f913842e2023-11-23T20:44:42ZengMDPI AGLife2075-17292022-01-0112213810.3390/life12020138Can The ‘Speed Bump Sign’ Be a Diagnostic Tool for Acute Appendicitis? Evidence-Based Appraisal by Meta-Analysis and GRADELing Wang0Ching-Hsien Ling1Pei-Chun Lai2Yen-Ta Huang3Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, TaiwanDepartment of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, TaiwanEducational Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, TaiwanDepartment of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, TaiwanObjectives: The ‘speed bump sign’ is a clinical symptom characterised by aggravated abdominal pain while driving over speed bumps. This study aimed to perform a diagnostic meta-analysis, rate the certainty of evidence (CoE) and analyse the applicability of the speed bump sign in the diagnosis of acute appendicitis. Materials and Methods: Four databanks and websites were systemically searched, and the Quality Assessment of Diagnostic Accuracy Studies 2 was used to evaluate the risk of bias. Meta-analysis was assessed by MIDAS commands in Stata 15. Grading of Recommendations, Assessment, Development and Evaluation methodology was applied to examine the CoE. Results: Four studies with 343 participants were included. The pooled sensitivity and specificity were 0.94 (95% CI (confidence interval) = 0.83–0.98; I<sup>2</sup> = 79%) and 0.49 (95% CI = 0.33–0.66; I<sup>2</sup> = 67%), respectively. The area under the summary receiver operating characteristic curve was 0.78 (95% CI = 0.74–0.81). The diagnostic odds ratio was 14.1 (95% CI = 3.6–55.7). The pooled positive and negative likelihood ratios (LR (+) and LR (−)) were 1.84 (95% CI = 1.30–2.61) and 0.13 (95% CI = 0.04–0.41), respectively. According to Fagan’s nomogram plot, when the pretest probabilities were 25%, 50% and 75%, the related posttest probabilities increased to 38%, 65% and 85% calculated through LR (+), respectively, and the posttest probabilities were 4%, 12% and 28% calculated through LR (−), respectively. The overall CoEs were low and very low in sensitivity and specificity, respectively. Conclusion: Current evidence shows that the speed bump sign is a useful ‘rule-out’ test for diagnosing acute appendicitis. With good accessibility, the speed bump sign may be added as a routine part of taking the history of patients with abdominal pain.https://www.mdpi.com/2075-1729/12/2/138speed bump signdiagnosismeta-analysisacute appendicitis |
| spellingShingle | Ling Wang Ching-Hsien Ling Pei-Chun Lai Yen-Ta Huang Can The ‘Speed Bump Sign’ Be a Diagnostic Tool for Acute Appendicitis? Evidence-Based Appraisal by Meta-Analysis and GRADE Life speed bump sign diagnosis meta-analysis acute appendicitis |
| title | Can The ‘Speed Bump Sign’ Be a Diagnostic Tool for Acute Appendicitis? Evidence-Based Appraisal by Meta-Analysis and GRADE |
| title_full | Can The ‘Speed Bump Sign’ Be a Diagnostic Tool for Acute Appendicitis? Evidence-Based Appraisal by Meta-Analysis and GRADE |
| title_fullStr | Can The ‘Speed Bump Sign’ Be a Diagnostic Tool for Acute Appendicitis? Evidence-Based Appraisal by Meta-Analysis and GRADE |
| title_full_unstemmed | Can The ‘Speed Bump Sign’ Be a Diagnostic Tool for Acute Appendicitis? Evidence-Based Appraisal by Meta-Analysis and GRADE |
| title_short | Can The ‘Speed Bump Sign’ Be a Diagnostic Tool for Acute Appendicitis? Evidence-Based Appraisal by Meta-Analysis and GRADE |
| title_sort | can the speed bump sign be a diagnostic tool for acute appendicitis evidence based appraisal by meta analysis and grade |
| topic | speed bump sign diagnosis meta-analysis acute appendicitis |
| url | https://www.mdpi.com/2075-1729/12/2/138 |
| work_keys_str_mv | AT lingwang canthespeedbumpsignbeadiagnostictoolforacuteappendicitisevidencebasedappraisalbymetaanalysisandgrade AT chinghsienling canthespeedbumpsignbeadiagnostictoolforacuteappendicitisevidencebasedappraisalbymetaanalysisandgrade AT peichunlai canthespeedbumpsignbeadiagnostictoolforacuteappendicitisevidencebasedappraisalbymetaanalysisandgrade AT yentahuang canthespeedbumpsignbeadiagnostictoolforacuteappendicitisevidencebasedappraisalbymetaanalysisandgrade |