Pinch test: a reliable physical sign for management of acute appendicitis

Abstract

Introduction: Acute appendicitis is often a surgical emergency. It primarily affects the growing children and needs to be evaluated early. Many patients of acute appendicitis will respond to antibiotics therapy. But a number of such patients will face recurrence and complications thereby pitting their lives in risk. To overcome such accidents acute appendicitis need to be diagnosed early and categorized so as to decide which group will benefit from conservative therapy and who will need emergency operation. The diagnosis of acute appendicitis is based on history and physical examination of the abdomen. Laboratory tests like leukocytosis > 10000/cu.mm and left shift of the Differential leukocyte count are important tests to understand the severity of acute appendicitis. The ALVARADO Score is also widely used for the idea for a better management of acute appendicitis. Pinch test is a single parameter finding to diagnose acute appendicitis. It is a simple examination technique, can be done bedside and more comfortable for the patients. Methods: 100 consecutive patients were taken up for the study. Detailed clinical examination was done. Diagnosis was based on primarily physical findings and history. Investigations were undertaken and Pinch test and its results were documented in all the cases. Alvarado scoring was also done. All patients were operated and co-related to the findings with Pinch test recorded. Result: Out of 100 cases, 59 were females and 41 were males, which showed slight female preponderance of the diseases. The patients were in the age group of 11 to 30 years with a median age of 21 years. The initial sensitivity and specificity of pinch test was 86.36% and 83.33%. In comparison the modified ALVARADO (MASS) score, it was 90.90% and 33.33% respectively. Pinch Test can be a tool to identify the cases of Appendicitis, which need urgent operative treatment. Conclusion: Pinch test can be an additional sign to identify cases of acute appendicitis which will need emergency surgery.