title: Effect of pain control in suspected acute appendicitis on the diagnostic accuracy of surgical residents.
abstract: OBJECTIVE
  To determine the influence of early pain relief for patients with suspected appendicitis on the diagnostic performance of surgical residents.
  
  
  METHODS
  A prospective randomized, double-blind, placebo-controlled trial was conducted for patients with suspected appendicitis. The patients were randomized to receive placebo (normal saline intravenous [IV]) infusions over 5 minutes or the study drug (morphine 5 mg IV). All of the clinical evaluations by surgical residents were performed 30 minutes after administration of the study drug or placebo. After obtaining the clinical probability of appendicitis, as determined by the surgical residents, abdominal computed tomography was performed. The primary objective was to compare the influence of IV morphine on the ability of surgical residents to diagnose appendicitis.
  
  
  RESULTS
  A total of 213 patients with suspected appendicitis were enrolled. Of these patients, 107 patients received morphine, and 106 patients received placebo saline. The negative appendectomy percentages in each group were similar (3.8% in the placebo group and 3.2% in the pain control group, p=0.62). The perforation rates in each group were also similar (18.9% in the placebo group and 14.3% in the pain control group, p=0.75). Receiver operating characteristic analysis revealed that the overall diagnostic accuracy in each group was similar (the area under the curve of the placebo group and the pain control group was 0.63 v. 0.61, respectively, p=0.81).
  
  
  CONCLUSIONS
  Early pain control in patients with suspected appendicitis does not affect the diagnostic performance of surgical residents.
authors.affiliation: *Emergency Medicine Department,Jeju National University Hospital,Jeju-si,Republic of Korea.
authors.forename: KyeongWon
authors.initials: K
authors.lastname: Kang
authors.affiliation: *Emergency Medicine Department,Jeju National University Hospital,Jeju-si,Republic of Korea.
authors.forename: Woo Jeong
authors.initials: WJ
authors.lastname: Kim
authors.affiliation: †Emergency Department,Seoul National University Bundang Hospital,Sungnam-si,Republic of Korea.
authors.forename: Kyuseok
authors.initials: K
authors.lastname: Kim
authors.affiliation: †Emergency Department,Seoul National University Bundang Hospital,Sungnam-si,Republic of Korea.
authors.forename: You Hwan
authors.initials: YH
authors.lastname: Jo
authors.affiliation: †Emergency Department,Seoul National University Bundang Hospital,Sungnam-si,Republic of Korea.
authors.forename: Joong Eui
authors.initials: JE
authors.lastname: Rhee
authors.affiliation: †Emergency Department,Seoul National University Bundang Hospital,Sungnam-si,Republic of Korea.
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Lee
authors.affiliation: †Emergency Department,Seoul National University Bundang Hospital,Sungnam-si,Republic of Korea.
authors.forename: Yu-jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: †Emergency Department,Seoul National University Bundang Hospital,Sungnam-si,Republic of Korea.
authors.forename: JaeHuk
authors.initials: J
authors.lastname: Lee
authors.affiliation: ‡Department of Surgery,Seoul National University Bundang Hospital,Sungnam-si,Republic of Korea.
authors.forename: Sung-Bum
authors.initials: SB
authors.lastname: Kang
authors.affiliation: ‡Department of Surgery,Seoul National University Bundang Hospital,Sungnam-si,Republic of Korea.
authors.forename: Duck-Woo
authors.initials: DW
authors.lastname: Kim
authors.affiliation: §Department of Radiology,Seoul National University Bundang Hospital,Sungnam-si,Republic of Korea.
authors.forename: Kyung-Ho
authors.initials: KH
authors.lastname: Lee
authors.affiliation: §Department of Radiology,Seoul National University Bundang Hospital,Sungnam-si,Republic of Korea.
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Kim
authors.affiliation: †Emergency Department,Seoul National University Bundang Hospital,Sungnam-si,Republic of Korea.
authors.forename: Hyun Mi
authors.initials: HM
authors.lastname: Park
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004311:Double-Blind Method; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D013502:General Surgery / Q000193:education*; D006801:Humans; D007262:Infusions, Intravenous; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D059408:Pain Management / Q000592:standards*; D011446:Prospective Studies; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: morphine