What are the sensitivity and specificity of Murphy's sign (Gallbladder Murphy's sign)?

From the Guidelines

Murphy's sign has a sensitivity of 0.48 and a specificity of 0.79 for the diagnosis of acute cholecystitis in the elderly population. This physical examination technique is used to assess for gallbladder inflammation, but its diagnostic accuracy can be limited, particularly in older adults. According to a study published in 2019 1, the sensitivity and specificity of Murphy's sign in elderly patients were reported to be 0.48 and 0.79, respectively.

Key Points to Consider

• The sensitivity of Murphy's sign is relatively low, which means that a negative result does not necessarily rule out acute cholecystitis.
• The specificity of Murphy's sign is moderate, indicating that a positive result is fairly reliable in confirming the diagnosis, but not definitive.
• The diagnostic accuracy of Murphy's sign may be influenced by various factors, such as age, comorbidities, and pain medication use.
• A combination of symptoms, signs, and laboratory test results may have better diagnostic accuracy in confirming the diagnosis of acute cholecystitis, as stated in the guidelines 1.

Clinical Implications

• Clinicians should be cautious when interpreting the results of Murphy's sign, particularly in elderly patients, and consider other diagnostic tools and clinical features to confirm the diagnosis of acute cholecystitis.
• The relatively low sensitivity of Murphy's sign highlights the importance of a comprehensive clinical evaluation, including laboratory tests and imaging studies, to establish an accurate diagnosis.

From the Research

Sensitivity and Specificity of Murphy's Sign

The sensitivity and specificity of Murphy's sign vary across different studies:

• In a prospective evaluation of 427 consecutive patients, the sensitivity of the sonographic Murphy sign was 63% and specificity was 93.6% 2
• A study of 200 patients with right upper quadrant pain reported a sensitivity of 86% and a specificity of 35% for the sonographic Murphy sign 3
• In a series of 18 patients with pathologically proved gangrenous cholecystitis, the sonographic Murphy sign was positive in only 33% of patients 4
• A retrospective assessment of elderly patients found a sensitivity of 0.48 and a specificity of 0.79 for Murphy's sign 5

Comparison of Studies

The studies demonstrate varying results for the sensitivity and specificity of Murphy's sign:

• The highest sensitivity reported was 86% 3, while the lowest was 33% 4
• The highest specificity reported was 93.6% 2, while the lowest was 35% 3
• The positive predictive value of Murphy's sign also varied, ranging from 43% 3 to 72.5% 2
• The negative predictive value ranged from 82% 3 to 90.5% 2