***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To evaluate the effects of intravenous morphine on pain reduction , physical examination , and diagnostic accuracy in children with acute abdominal pain . METHODS A r and omized , double-blind , placebo-controlled clinical trial was conducted at an emergency department of a tertiary care children 's hospital . Children aged 5 - 18 years with abdominal pain of < or = 5 days ' duration , pain score > or = 5 on a 0 - 10 visual analog scale , and need for surgical evaluation were eligible . Following the initial assessment , patients were r and omized to receive either 0.1 mg/kg morphine or an equal volume of saline . The pediatric emergency medicine physician and surgical consultant independently recorded the areas of tenderness to palpation and percussion , and their diagnoses before the study medication and 15 to 30 minutes later . RESULTS Sixty patients were enrolled , and 29 received morphine and 31 received saline . The demographic characteristics between the two groups were similar . The median reduction of pain score between the two study groups was 2 ( 95 % CI = 1 to 4 ; p = 0.002 ) . There was no significant change in the areas of tenderness in both study groups . Children with surgical conditions had persistent tenderness to palpation and /or percussion . There was no significant change in the diagnostic accuracy between the study groups and between the physician groups . All patients requiring laparotomy were identified and no significant complication was noted in the morphine group . CONCLUSIONS Intravenous morphine provides significant pain reduction to children with acute abdominal pain without adversely affecting the examination , and morphine does not affect the ability to identify children with surgical conditions Aim : To see whether laparoscopy improves the accuracy of a clinical diagnosis of acute appendicitis in women of reproductive age , and to determine what the long-term sequelae are of not removing an appendix deemed at laparoscopy to be normal . Method : The initial part of the study was undertaken during 1991–1992 . Female patients between 16 and 45 years were eligible for inclusion once a clinical decision had been made to perform an appendicectomy for suspected acute appendicitis . Following consent , patients were r and omized into two groups . One group had open appendicectomy , as planned . The other group had laparoscopy , followed by open appendicectomy only if the appendix was seen to be inflamed or was not visualized . The end points for the study were the clinical outcomes of all patients , and the results of histology , where appropriate . An attempt was made to contact all patients at 10 years to determine whether they had had a subsequent appendicectomy , or had been diagnosed with another abdominal condition that might be relevant to the initial presentation in 1991–1992 . Results : Laparoscopic assessment was correct in all cases in which the appendix was visualized . Diagnostic accuracy was improved from 75 % to 97 % . Laparoscopy was associated with no added complications , no increase in hospital stay in patients who went on to appendicectomy , and a reduction in hospital stay for those who underwent laparoscopy alone . No patients developed a problem over the 10-year follow-up period from having a normal-looking appendix not removed at laparoscopy . Conclusion : Laparoscopic assessment of the appendix is reliable , and to leave a normal-looking appendix at laparoscopy does not appear to cause any long-term problems OBJECTIVES The total white blood cell ( WBC ) count and temperature are often expected to be elevated in patients with appendicitis . Clinicians often use the results of these parameters in making a judgment about the presence or absence of disease . The objective of this study was to assess the discriminatory value of the  total WBC count  and  presenting body temperature  in patients presenting to the emergency department ( ED ) with signs and symptoms suggestive of appendicitis . METHODS This was a prospect i ve consecutive case series in a university ED with an annual census of 38,000 . All patients presenting to the ED in whom the diagnosis of appendicitis was the attending physician 's primary consideration were enrolled . Measures included age , gender , symptoms , physical findings , patient temperature as taken in the ED , initial total WBC count , and discharge diagnosis . Admitted patients were followed up until surgical or clinical outcomes , and discharged patients were followed up by telephone two weeks after the initial visit . All statistical analysis was performed using StatsDirect version 1.9.8 . RESULTS A total of 293 patients were enrolled over a two-year study period . The total WBC count was measured in 274 cases , and the temperature was measured in 293 cases . There were 130 male patients and 163 female patients . The mean age of the patients was 30.8 years ( range , 7 - 75 years ) .  Appendicitis was confirmed in 92 patients . In this study group of patients , a total WBC count > 10,000 cells/mm(3 ) had a sensitivity of 76 % ( 95 % confidence interval [ 95 % CI ] = 65 % to 84 % ) and a specificity of 52 % ( 95 % CI = 45 % to 60 % ) . The positive predictive value ( PPV ) was 42 % ( 95 % CI = 35 % to 51 % ) , and the negative predictive value ( NPV ) was 82 % ( 95 % CI = 74 % to 89 % ) . The positive likelihood ratio ( LR ) was 1.59 ( 95 % CI = 1.31 to 1.93 ) , and the negative LR was 0.46 ( 95 % CI = 0.31 to 0.67 ) . A temperature > 99.0 degrees F had a sensitivity of 47 % ( 95 % CI = 36 % to 57 % ) and a specificity of 64 % ( 95 % CI = 57 % to 71 % ) . The PPV was 37 % ( 95 % CI = 29 % to 46 % ) , and the NPV was 72 % ( 95 % CI = 65 % to 79 % ) . The positive LR was 1.3 ( 95 % CI = 0.97 to 1.72 ) , and the negative LR was 0.82 ( 95 % CI = 0.65 to 1.01 ) . The areas under the curve for the receiver-operating characteristic ( ROC ) curve were 0.72 ( 95 % CI = 0.65 to 0.79 ) and 0.59 ( 95 % CI = 0.52 to 0.66 ) for an elevated total WBC count and an elevated temperature , respectively . CONCLUSIONS An elevated total WBC count > 10,000 cells/mm(3 ) , while statistically associated with the presence of appendicitis , had very poor sensitivity and specificity and almost no clinical utility . There was minimal statistical association between a temperature of > 99 degrees F and the presence of appendicitis . The ROC curve suggests there is no value of total WBC count or temperature that has sufficient sensitivity and specificity to be of clinical value in the diagnosis of appendicitis . Clinicians should be wary of reliance on either elevated temperature or total WBC count as an indicator of the presence of appendicitis HYPOTHESIS Ultrasonography can be efficiently performed using new criteria for the diagnosis of acute appendicitis . DESIGN Prospect i ve trial . PATIENTS Eighty-nine patients admitted to the hospital with suspected appendicitis between March 1998 and November 2000 . INTERVENTION At hospital admission , a staff surgeon evaluated each patient and determined whether the patient had appendicitis requiring immediate surgery or another disease . Patients then underwent ultrasonography . A sonographic transducer was placed on the area of maximal tenderness . When the pathological manifestation was depicted , the examiner slipped a fingertip between the transducer and the patient 's skin and then pressed the area of depicted pathological manifestation to find pinpoint tenderness . When maximal pinpoint tenderness was noted on the appendix or on pathological manifestations contiguous to the appendix , we diagnosed the condition as appendicitis . MAIN OUTCOME MEASURES Sensitivity , specificity , positive and negative predictive values , and overall accuracy . RESULTS The diagnosis of appendicitis by this criteria had a sensitivity of 86.7 % , a specificity of 89.7 % , a positive predictive value of 94.5 % , a negative predictive value of 76.5 % , and overall accuracy of 87.6 % . All 50 patients with pinpoint tenderness  noted on the appendix had appendicitis . The surgeon 's initial clinical impression had a sensitivity of 83.3 % , a specificity of 44.8 % , a positive predictive value of 75.8 % , a negative predictive value of 56.5 % , and overall accuracy of 70.8 % . CONCLUSIONS The efficacy of ultrasonography using the simple criteria was superior to that of the surgeon 's initial clinical impression ( P<.001 ) . Our ultrasonographic criteria for the diagnosis of appendicitis are simple to use and efficient The objective of this study was to examine current practice patterns of analgesia administration among emergency physicians ( EPs ) when caring for a patient with an acute abdomen . Cross sectional data were acquired by a survey mailed in October 1997 to 1,000 American College of Emergency Physicians ( ACEP ) members from a purchased ACEP mailing list which contained 1,000 r and omized ACEP members . A repeat survey was sent to nonresponders 2 months later and a r and om subset of recurrent nonresponders were telephoned . The question naire focused on physician demographics , practice patterns , and factors which influenced physician decision of when and whether to administer pain medication , specifically opiates , to patients with an acute abdomen . Forty-four percent of surveys were returned . Seventy-seven percent of respondents were men with an average of 10 years of experience . Fifty-seven percent were residency trained in emergency medicine . Although eighty-five percent felt that the conservative administration of pain medication did not change important physical findings on the physical examination , 76 % choose not to give an opiate analgesic until after the examination by a surgeon . Twenty-five percent of patients did not receive any pain medication in the department . In conclusion , although EPs report that the judicious administration of pain medication does not mask important examination findings , the majority wait until after the surgeon has evaluated the patient to deliver analgesics Abstract Objectives : To evaluate the impact of early abdominopelvic computed tomography in patients with acute abdominal pain of unknown cause on length of hospital stay and accuracy of diagnosis . Design : R and omised , prospect i ve controlled trial . Setting : Teaching hospital in Engl and . Participants : 120 patients admitted with acute abdominal pain for which no immediate surgical intervention or computed tomography was indicated . Intervention : 55 participants were prospect ively r and omised to early computed tomography  ( within 24 hours of admission ) and 65 to st and ard practice ( radiological investigations as indicated ) . Main outcome measures : Length of hospital stay , accuracy of diagnosis , and , owing to a possible effect on inpatient mortality , deaths during the study . Results : Early computed tomography reduced the length of hospital stay by 1.1 days ( geometric mean 5.3 days ( range 1 to 31 ) v 6.4 days ( 1 to 60 ) ) , but the difference was non-significant ( 95 % confidence interval , 8 % shorter stay to 56 % longer stay , P=0.17 ) . Early computed tomography missed significantly fewer serious diagnoses . Seven in patients in the st and ard practice arm died . Only 50 % ( 59 of 118 ) of diagnoses on admission were correct at follow up at 6 months , but this improved to 76 % ( 90 ) of diagnoses after 24 hours . Conclusions : Early abdominopelvic computed tomography for acute abdominal pain may reduce mortality and length of hospital stay . It can also identify unforeseen conditions and potentially serious complications . What is already known on this topic Computed tomography improves the accuracy of diagnosis of several acute abdominal conditions Uncontrolled studies have shown improvements in accuracy of diagnosis after computed tomography ; none have described an effect on mortality What this study adds Early abdominopelvic computed tomography for acute abdominal pain can identify unforeseen serious abdominal conditions It may also reduce length of hospital stay and might reduce inpatient BACKGROUND The accuracy of the clinical diagnosis of acute appendicitis in patients more than 50 years old was studied in connection with the Research Committee of the World Organization of Gastroenterology ( OMGE ) survey of acute abdominal pain . Criteria for inclusion and the diagnostic criteria in this prospect i ve study were those set out by the OMGE Research Committee . METHODS The clinical findings in each patient were recorded in detail , using a predefined structured data collection sheet , and the collected data were compared with the final diagnosis of the patients . Twenty-three preoperative clinical history variables , 14 clinical signs , and 3 tests were evaluated in a single variable and multivariate analysis . RESULTS In multivariate logistic regression analysis the most significant predictors of acute appendicitis in patients more than 50 years old were tenderness ( relative risk ( RR ) = 39.4 ) , rigidity ( RR = 18.8 ) , and pain at diagnosis ( RR = 11.0 ) . The sensitivity of the preoperative clinical decision is detecting acute appendicitis in the aged was 0.87 , with a specificity of 0.92 , an efficiency of 0.91 and a usefulness index ( UI ) of 0.69 . The computer-aided diagnostic score ( DS ) reached a sensitivity of 0.92 in detecting acute appendicitis , with a specificity of 0.90 and an efficiency of 0.90 . When the patients with a DS value between - 
    Output:
    
Improvement with use of opioid analgesia was verified in variables patient comfort , reduction of pain , changes in physical examination .
AUTHORS ' CONCLUSIONS The review provide some evidence to support the notion that the use of opioid analgesics in patients with acute abdominal pain is helpful in terms of patient comfort and does not retard decisions to treat