Takada Toshihiko, Ikusaka Masatomi, Ohira Yoshiyuki, Noda Kazutaka, Tsukamoto Tomoko
Department of General Medicine, Chiba University Hospital, Japan.
Intern Med. 2011;50(3):213-7. doi: 10.2169/internalmedicine.50.4179. Epub 2011 Feb 1.
Carnett's test is a simple clinical test in which abdominal tenderness is evaluated while the patient tenses the abdominal muscles. It is useful for differentiating abdominal wall pain from intra-abdominal pain. However, no study has reported its association with psychogenic abdominal pain. We evaluated its diagnostic usefulness in psychogenic abdominal pain.
Two physicians performed Carnett's test on each patient, but only one received the medical history. The other physician only conducted the test. Based on the final diagnosis, patients were categorized into 3 groups: psychogenic pain, abdominal wall pain, or intra-abdominal pain. Each group was analyzed in association with the results of Carnett's test conducted by the blinded physician.
A total of 130 outpatients with the chief complaint of abdominal pain who had abdominal tenderness.
There were 22 patients with psychogenic abdominal pain, 19 with abdominal wall pain and 62 with intra-abdominal pain. In patients with psychogenic pain or abdominal wall pain, Carnett's test was usually positive, whereas the test was usually negative in patients with intra-abdominal pain (p<0.001, respectively). The positive likelihood ratio of Carnett's test for psychogenic abdominal pain was 2.91 (95% confidence interval [CI], 2.71-3.13), while the negative likelihood ratio was 0.19 (95% CI, 0.11-0.34). The corresponding values for abdominal wall pain were 2.62 (95% CI, 2.45-2.81) and 0.23 (95% CI, 0.13-0.41), respectively.
Carnett's test may be useful for ruling in and ruling out psychogenic abdominal pain in addition to distinguishing between abdominal wall pain and intra-abdominal pain.
卡内特试验是一种简单的临床检查，即让患者收紧腹部肌肉时评估腹部压痛情况。它有助于区分腹壁疼痛和腹腔内疼痛。然而，尚无研究报道其与心因性腹痛的关联。我们评估了其在心因性腹痛中的诊断效用。
两名医生对每位患者进行卡内特试验，但只有一名医生了解病史。另一名医生仅进行检查。根据最终诊断，将患者分为三组：心因性疼痛、腹壁疼痛或腹腔内疼痛。将每组与不知情医生进行的卡内特试验结果相关联进行分析。
共有130例以腹痛为主诉且有腹部压痛的门诊患者。
有22例心因性腹痛患者、19例腹壁疼痛患者和62例腹腔内疼痛患者。在心因性疼痛或腹壁疼痛患者中，卡内特试验通常为阳性，而在腹腔内疼痛患者中该试验通常为阴性（p均<0.001）。卡内特试验在心因性腹痛中的阳性似然比为2.91（95%置信区间[CI]，2.71 - 3.13），阴性似然比为0.19（95%CI，0.11 - 0.34）。腹壁疼痛的相应值分别为2.62（95%CI，2.45 - 2.81）和0.23（95%CI，0.13 - 0.41）。
卡内特试验除了有助于区分腹壁疼痛和腹腔内疼痛外，可能还有助于确诊和排除心因性腹痛。
