***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 
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    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 Background : The administration of analgesics to patients with acute abdominal pain due to acute appendicitis is controversial . A study was undertaken to assess the analgesic effect of morphine in patients with acute appendicitis . Methods : A r and omised double-blind clinical trial was conducted in Sina hospital , a general teaching hospital , from January 2004 to March 2005 . Patients scheduled for appendectomy were r and omised to receive 0.1 mg/kg morphine sulfate or saline ( 0.9 % ) to a maximum dose of 10 mg over a 5 min period . Patients were examined by surgeons not involved in their care before and after drug administration and their pain intensity and signs were recorded at each visit . The physicians were also asked to indicate their own treatment plan . The main outcome measures were pain intensity using a visual analogue scale ( VAS ) and signs of acute appendicitis . A favourable reduction in VAS score was defined as a change of > 13 mm . Results : Of the 71 patients enrolled in the study , 35 were allocated to receive morphine and 36 to receive placebo . One patient left the hospital before receiving morphine . No significant differences were seen between the two groups with regard to age , sex and initial VAS score . A more favourable change in VAS score was reported in the morphine group with a significantly greater reduction in the median VAS score than in the placebo group . Morphine administration did not cause significant changes in patients ’ signs or in the physicians ’ plans or diagnoses . No adverse events were seen in either group . Conclusion : Morphine can reduce pain in patients with acute appendicitis without affecting diagnostic accuracy . Trial registration number : NCT00477061 In a prospect i ve sequential double blind trial 288 patients with acute abdominal pain were given sublingual buprenorphine 200 mcg , sublingual buprenorphine 400 mcg , or placebo .  Pain relief was proportional to the number of tablets administered ; buprenorphine had no difference in effect compared to placebo .  Physical signs altered in proportion to dosage , but this had no effect on clinical diagnosis . We conclude that patients with acute abdominal pain may be given buprenorphine without fear of masking the diagnosis 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 BACKGROUND Analgesics for children with acute abdominal pain are often withheld for fear that they might mask physical examination findings and thus might be unsafe . This viewpoint has been challenged recently . OBJECTIVE To evaluate the effects of buccal oxycodone on pain relief , physical examination findings , diagnostic accuracy , and final clinical outcomes in children with acute abdominal pain . DESIGN Prospect i ve , r and omized , double-blind , and placebo-controlled trial between December 2001 and November 2003 . SETTING University teaching hospital in Finl and . Patients A total of 104 children aged 4 to 15 years with abdominal pain of less than 7 days ' duration were screened , and 63 children with pain scores of 5 or higher on a 10-cm visual analog scale were eligible for the trial . Intervention Children were r and omized to receive buccally either 0.1 mg/kg(-1 ) of oxycodone hydrochloride ( n = 32 ) or the same volume of normal saline ( n = 31 ) . The same surgeon described the physical findings and indicated a provisional diagnosis and a provisional disposition before the children received the study medication and at 1 hour and  
    Output:
    
Differences with use of opioid analgesia were verified in variables : Change in the intensity of the pain , change in the patients comfort level .
AUTHORS ' CONCLUSIONS The use of opioid analgesics in the therapeutic diagnosis of patients with AAP does not increase the risk of diagnosis error or the risk of error in making decisions regarding treatment