[Diagnosis of appendicitis with particular consideration of the acupuncture point Lanwei--a prospective study].
BACKGROUND
In almost all Western industrial nations, appendicitis is the most frequent cause for acute abdomen. Nevertheless, the diagnosis of appendicitis is often difficult, which manifests in highly negative laparotomy rates. In a prospective study we aimed to investigate if palpation of the acupuncture point Lanwei (extra point 22, extra point 33) which is located on the right leg may increase the accuracy in the diagnosis of appendicitis.


METHODS
Presurgically, the Lanwei point was examined for reproducible tenderness on 116 cooperative nonanesthetized patients admitted to hospital for suspected appendicitis. The results were compared with those of histological diagnosis. The examination of tenderness of the Lanwei sign was performed without knowing the results of other examinations. Additionally, other signs and laboratory parameters for appendicitis were examined using a standardized documentation form. Altogether, 17 presurgical variables, 18 clinical signs, and 3 tests were evaluated.


RESULTS
A positive Lanwei sign was documented in 65 cases (56%), whereas 51 patients (44%) had a negative Lanwei sign. 65 of the 116 patients were operated. 59 of those had a histologically proven appendicitis. The sensitivity of the Lanwei sign was 64.4%, specificity ranged at 50%. Rates for positive and negative predictive values were 92.7% and 12.5%, respectively. Odds ratio was estimated as 1.8. When comparing these parameters, the Lanwei sign ranged between the 7th and 10th place of the 22 most important clinical signs for appendicitis. The negative laparotomy rate was 9%, of which 4 of 6 patients had other indications for an operation. The rate of perforation was 15%.


CONCLUSIONS
Compared with many conventional signs for appendicitis as for example Mc Burney, tender Sherren triangle, reduced peristalsis, the diagnostic value of the Lanwei sign is not sufficient. Although a reproducible positive Lanwei sign is a good hint for a true appendicitis, in case of a negative Lanwei sign the probability for an appendicitis may be relatively high. Because of the low negative predictive value, the Lanwei sign is not suitable for reducing negative laparatomy rates. As in many other studies, the one and only indicator for appendicitis which yields high results in all statistical parameters was not detected in this study. In comparison to the statistical parameters of traditional signs for appendicitis, the Lanwei sign cannot be regarded as a good diagnostic parameter for appendicitis.
Alt-Epping
S
S
Universität Witten/Herdecke, Fakultät für Medizin, Witten/Herdecke. sabine.ae@gmx.net
Ostermann
T
T
Schmidt
J
J
Zirngibl
H
H
D015669:Acupuncture Points; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity