Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jan 19, 2021
Open Peer Review Period: Jan 19, 2021 - Mar 16, 2021
Date Accepted: Jun 14, 2021
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Segmental Signs and Spontaneous Pain in Acute Visceral Disease: An observational study
ABSTRACT
Background:
The differential diagnosis of acute visceral diseases is a challenging clinical problem. The older literature suggests that patients with acute visceral problems show segmental signs, such as hyperalgesia, skin resistance, or muscular defence, whose lateralization and segmental distribution may be used for differential diagnosis.
Objective:
This study aimed to investigate the lateralization and segmental distribution of spontaneous pain and segmental signs in acute visceral diseases using digital pain drawing technology.
Methods:
We recruited 208 emergency room patients that were presenting for acute medical problems. All patients underwent a structured 10-minute bodily examination to test for various segmental signs and were asked for spontaneous pain and segmental symptoms, such as nausea, meteorism, and urinary retention. We collected all findings as digital drawings on a tablet-PC. After the final diagnosis, patients were divided into groups according to the organ affected. Using statistical image analysis, we calculated average distributions of pain and segmental signs for the heart, lungs, stomach, liver/gallbladder, and kidneys/ureters analyzing their segmental distribution and lateralization.
Results:
85 of 110 patients with a single-organ problem reported pain, while 81 had at least one segmental sign, the most frequent being hyperalgesia (n=46), and muscle resistance (n=39). While the pain was distributed along the body midline, segmental signs for the heart, stomach and liver/gallbladder appeared mostly ipsilateral to the affected organ. An unexpectedly high number of patients (n=37) further showed ipsilateral mydriasis.
Conclusions:
The present study underlines the usefulness of including digitally-recorded segmental signs in the bodily examination of patients with acute medical problems.
Citation
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Copyright
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