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(Radiology. 1999;210:639-643.)
© RSNA, 1999

Gastrointestinal Imaging

Acute Appendicitis: Influence of Early Pain Relief on the Accuracy of Clinical and US Findings in the Decision to Operate—A Randomized Trial

Bernard Vermeulen, MD1, Alfredo Morabia, MD2, Pierre-François Unger, MD1, Catherine Goehring, MD2, Christian Grangier, MD3, Igor Skljarov, MD3 and François Terrier, MD3

1 Emergency Department (B.V., P.F.U.)
2 Clinical Epidemiology Division (A.M., C. Goehring)
3 Radiology Department (C. Grangier, I.S., F.T.), Hôpitaux Universitaires de Genève, Rue Micheli-de-Crest 24, CH-1211 Genève 14, Switzerland.

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.

Index terms: Anesthesia • Appendicitis, 751.291, 752.291 • Appendix, US, 751.1298, 752.1298 • Ultrasound (US), utilization, 751.1298, 752.1298




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