Wang Ling, Ling Ching-Hsien, Lai Pei-Chun, Huang Yen-Ta
Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan.
Life (Basel). 2022 Jan 18;12(2):138. doi: 10.3390/life12020138.
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.
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.
Four studies with 343 participants were included. The pooled sensitivity and specificity were 0.94 (95% CI (confidence interval) = 0.83-0.98; I = 79%) and 0.49 (95% CI = 0.33-0.66; I = 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.
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.
“减速带征”是一种临床症状，其特征为在驶过减速带时腹痛加剧。本研究旨在进行诊断性荟萃分析，评估证据确定性（CoE），并分析减速带征在急性阑尾炎诊断中的适用性。
系统检索了四个数据库和网站，并使用诊断准确性研究的质量评估2来评估偏倚风险。通过Stata 15中的MIDAS命令进行荟萃分析。应用推荐分级、评估、制定和评价方法来检查CoE。
纳入了四项研究，共343名参与者。合并敏感度和特异度分别为0.94（95%置信区间（CI）=0.83 - 0.98；I² = 79%）和0.49（95%CI = 0.33 - 0.66；I² = 67%）。汇总受试者工作特征曲线下面积为0.78（95%CI = 0.74 - 0.81）。诊断比值比为14.1（95%CI = 3.6 - 55.7）。合并阳性和阴性似然比（LR(+)和LR(-)）分别为1.84（95%CI = 1.30 - 2.61）和0.13（95%CI = 0.04 - 0.41）。根据费根列线图，当验前概率为25%、50%和75%时，通过LR(+)计算的相关验后概率分别增至38%、65%和85%，通过LR(-)计算的验后概率分别为4%、12%和28%。总体CoE在敏感度和特异度方面分别为低和极低。
当前证据表明，减速带征是诊断急性阑尾炎的一项有用的“排除”试验。鉴于其良好的可及性，减速带征可作为腹痛患者病史采集的常规部分补充内容。
