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Murphy's sign, acute cholecystitis and elderly people
1Department of Surgery, Airedale General Hospital, Keighley, West Yorkshire.
Journal of the Royal College of Surgeons of Edinburgh
|April 1, 1996
Summary
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.