University of California, San Francisco (UCSF), Fresno Medical Education Program, Department of Emergency Medicine, Division of Medical Toxicology, 155. N. Fresno Street, Fresno, CA 93701, United States of America.
Am J Emerg Med. 2020 Dec;38(12):2759.e1-2759.e4. doi: 10.1016/j.ajem.2020.05.077. Epub 2020 May 27.
Carnett's sign (CAR) and Closed Eye sign (CE) have been suggested for use in the emergency department setting in the management of abdominal pain. The present study sought to determine the sensitivity/specificity of CAR and CE for pathological CT findings as a primary outcome and for subsequent hospital admission or surgical intervention as secondary outcomes in a community emergency department setting.
A convenience sample of adults (≥18 y) presenting with acute (<48 h) nontraumatic and non-postoperative abdominal pain determined by treating provider to warrant CT imaging were eligible for enrollment. Treating providers completed a datasheet describing physical examination findings prior to CT imaging.
320 patients were enrolled. 245/320 (76.5%) of enrolled patients had findings on CT Imaging. CAR+ was recorded in 145 and CAR- in 175 patients. CE+ was in 187 and CAR- in 133 patients. Sensitivity and specificity of CAR- for hospital admission was 42.2% and 38.9% and for surgery-44.8% and 43.1%. Sensitivity and specificity of CE- for hospital admission was 28% and 51.6% and for surgery-25.9% and 55%. CAR+ patients were more likely to be admitted or undergo surgery as compared to CAR-. CE+ patients were more likely to be admitted or undergo surgery as compared to CAR-. There were no differences in frequency of pathological CT findings between CAR+ and CAR- or CE+ and CE- patients.
CAR and CE are neither sufficiently sensitive nor specific for use in the emergency department setting. CT findings were equally likely in CAR+ and CAR- patients. CT Findings were also equally likely in CE+ and CE- patients.
卡内特征（CAR）和闭眼征（CE）已被建议用于急诊科腹痛的管理。本研究旨在确定 CAR 和 CE 在社区急诊科环境中作为主要结局的病理性 CT 发现的敏感性/特异性，以及作为次要结局的随后住院或手术干预。
通过治疗提供者确定有资格进行 CT 成像的急性（<48 小时）非创伤性和非术后腹痛的成年（≥18 岁）患者的便利样本。治疗提供者在 CT 成像前填写数据表，描述体格检查结果。
共纳入 320 例患者。245/320（76.5%）的入组患者在 CT 成像上有发现。CAR+记录在 145 例，CAR-记录在 175 例。CE+在 187 例，CE-在 133 例。CAR-对住院的敏感性和特异性分别为 42.2%和 38.9%，对手术的敏感性和特异性分别为 44.8%和 43.1%。CE-对住院的敏感性和特异性分别为 28%和 51.6%，对手术的敏感性和特异性分别为 25.9%和 55%。与 CAR-相比，CAR+患者更有可能住院或接受手术。与 CAR-相比，CE+患者更有可能住院或接受手术。CAR+和 CAR-或 CE+和 CE-患者的 CT 异常发现频率无差异。
CAR 和 CE 在急诊科环境中既不敏感也不特异。CAR+和 CAR-患者的 CT 发现相似。CE+和 CE-患者的 CT 发现也相似。
