To the Editor.—The heel-drop jarring test for appendicitis and other intraperitoneal inflammation, also known as the Markle test, was published in 1973 and, as a simple bedside test, was shown to be superior to the better-known rebound test.1 A recent review of a series of 190 appendectomies confirmed this advantage and in addition, the test was found to be at least as accurate as the white blood cell (WBC) count and differential cell count.
In a series of 190 appendectomies the appendix was normal in 30 patients (15.8%). Seventy-four percent of the patients with acute appendicitis had a positive heel-drop test, with helpful localization in 71% compared with 64% and 37% for the rebound test, respectively. The WBC count was at least 10,000/cu mm in 69% of the patients and the differential cell count was 68 or more (totals of neutrophils plus immature forms) in 71% of the
MARKLE GB. Heel-Drop Jarring Test for Appendicitis. Arch Surg. 1985;120(2):243. doi:10.1001/archsurg.1985.01390260101015