Bedside pressure-pain threshold algometry to measure abdominal tenderness in childhood appendicitis: A retrospective cohort study
Bibliographic record
Abstract
ABSTRACT Introduction: Abdominal wall tenderness and its localization are key diagnostic features of appendicitis. However, abdominal wall tenderness assessment is subjective, and its utility in the diagnostic discrimination of appendicitis is limited. The objective of this study is to assess whether measuring abdominal tenderness using algometry can improve the clinical assessment of children with suspected appendicitis. Methods: Using a spring-gauge, pocket-size algometer, similar to a tire gauge, we measured abdominal wall pressure-pain thresholds and tenderness localization ratios in children with suspected appendicitis referred to one pediatric general surgeon. We correlated the results with the final diagnosis, standard diagnostic scores, and abdominal ultrasound. Results: Of 557 children with suspected appendicitis, 421 (76%) had algometry measurements of whom 239 (57%) underwent appendectomy. Appendicitis was confirmed in 216 (90%); appendicitis prevalence 51%. Pressure-pain thresholds were significantly lower and tenderness localization ratios higher in appendicitis. The difference was greatest with perforation: maximum AUC 0.884 overall, in males AUC 0.935. During observation, pressure-pain thresholds decreased while tenderness localization ratio increased in appendicitis patients, signaling increasing tenderness and more precise localization for appendicitis. The reverse was observed for non-appendicitis patients. Localization ratios were superior to the two standard diagnostic appendicitis scores (Algometry AUC = 0.844; Alvarado AUC = 0.790, pediatric appendicitis score AUC = 0.760) and white blood cell count alone (AUC = 0.728). Algometry results yielded positive and negative predictive values up to 100%. Conclusion: Bedside measurements of abdominal wall tenderness outperformed individual clinical and laboratory parameters and appendicitis diagnostic scores in identifying acute appendicitis. If validated and given its ease, algometry has the potential for incorporation into clinical practice, documentation, and as a quantifiable tenderness measure for use in clinical research. Highlights
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".