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Can The 'Speed Bump Sign' Be a Diagnostic Tool for Acute Appendicitis? Evidence-Based Appraisal by Meta-Analysis and
Ling Wang1, Ching-Hsien Ling2, Pei-Chun Lai3
1Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
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; I2 = 79%) and 0.49 (95% CI = 0.33-0.66; I2 = 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.
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