February 26, 1997

Does This Patient Have Appendicitis?-Reply

Author Affiliations

University of Texas Southwestern Medical School Dallas

JAMA. 1997;277(8):626-627. doi:10.1001/jama.1997.03540320028021

In Reply.  —Dr Schneider takes issue with our finding that anorexia has little impact on the diagnosis of appendicitis, which was based on the likelihood ratio of 1.27. In his practice, Schneider has noted how uncommon it is for patients with acute appendicitis to report that they are hungry. This observation attests to the sensitivity of anorexia, which we calculated at 68%. Indeed, anorexia is the third most sensitive sign or symptom of the 13 we evaluated. However, physicians do not accept this level of sensitivity for ruling out any disease, and we cannot explain the discrepancy between the data we analyzed and Schneider's experience.Drs Moustafa and Newton raise an important ethical question: Is the test for rebound tenderness humane or even necessary? Based on the power of the test disclosed by our review, we would have to conclude that performing the test for rebound tenderness once is indeed necessary. However,