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Murphy's sign, acute cholecystitis and elderly people

O A Adedeji1, W A McAdam

  • 1Department of Surgery, Airedale General Hospital, Keighley, West Yorkshire.

Journal of the Royal College of Surgeons of Edinburgh
|April 1, 1996
PubMed

Insights

Murphy's sign aids acute cholecystitis diagnosis in elderly patients, but a negative result requires caution. Diagnostic accuracy is significantly lower when this classic sign is absent in older individuals.

Area of Science:

  • Geriatric Medicine
  • Surgical Gastroenterology
  • Diagnostic Accuracy

Background:

  • Acute abdomen presentation varies in elderly patients compared to younger populations.
  • Classical clinical signs may have altered diagnostic utility in geriatric patients.
  • Acute cholecystitis remains a common surgical emergency in the elderly.

Purpose of the Study:

  • To evaluate the impact of Murphy's sign on the initial diagnosis of acute cholecystitis in elderly patients.
  • To determine the diagnostic performance of Murphy's sign in this demographic.
  • To assess the reliability of classical signs in geriatric acute abdomen.

Main Methods:

  • Retrospective analysis of elderly patients presenting with acute abdomen.
  • Assessment of Murphy's sign presence or absence.
  • Calculation of diagnostic accuracy, sensitivity, specificity, and positive predictive value.

Main Results:

  • Diagnostic accuracy for acute cholecystitis was 80% with a positive Murphy's sign, decreasing to 34% when negative.
  • The positive predictive value was 0.58, with sensitivity of 0.48 and specificity of 0.79.
  • A positive Murphy's sign is indicative, but a negative sign has limited diagnostic power.

Conclusions:

  • Murphy's sign is a useful, though not definitive, indicator for acute cholecystitis in the elderly.
  • A negative Murphy's sign in elderly patients necessitates cautious interpretation and prompt consideration of further diagnostic tests.
  • Clinical signs in the elderly require careful evaluation due to potential atypical presentations.

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