Sensitivity and Specificity of Rovsing Sign for Diagnosing Appendicitis
The Rovsing sign has not been well studied, with limited data showing moderate specificity but poor sensitivity for diagnosing appendicitis, making it an unreliable standalone diagnostic tool.
Understanding Rovsing Sign
Rovsing sign is a physical examination finding where palpation of the left lower quadrant causes pain in the right lower quadrant, suggesting peritoneal irritation from appendicitis. However, the diagnostic accuracy of this sign has been inadequately studied in the medical literature.
Diagnostic Value of Rovsing Sign
Based on the available evidence, Rovsing sign has the following characteristics:
- Sensitivity: Low to moderate (likely below 70%)
- Specificity: Moderate (likely 60-80%)
The evidence regarding Rovsing sign is limited by:
- Lack of standardization in how the sign is performed
- Poor correlation with appendix position on imaging or surgical findings
- Translation issues in medical literature
- Variations in technique from the original description
Comparison with Other Diagnostic Methods
When comparing Rovsing sign to established diagnostic methods for appendicitis:
Imaging Modalities
- CT with IV contrast: 96% sensitivity, 93% specificity 1
- MRI: 96% sensitivity, 96% specificity 2
- Ultrasound: Variable performance with 82-99% sensitivity when results are definitive 1
Other Physical Examination Signs
- The recently studied "Amr sign" (neck hyperextension upon right iliac fossa palpation) shows 68.6% sensitivity and 67.3% specificity 3
- CT findings such as fat stranding (100% sensitivity, 80% specificity) and enlarged appendix >6mm (93% sensitivity, 100% specificity) are more reliable 4
Clinical Application
Physical examination signs like Rovsing sign should be interpreted with caution:
- A positive Rovsing sign may increase suspicion for appendicitis but cannot confirm the diagnosis
- A negative Rovsing sign does not exclude appendicitis 5
- These signs should be used as supplements to the overall clinical assessment
Pitfalls and Caveats
- Relying solely on physical examination signs like Rovsing sign may lead to missed diagnoses
- The technique for eliciting Rovsing sign is not standardized across medical practice
- The sign's accuracy may vary depending on the position of the appendix and extent of inflammation
- Physical examination findings should be correlated with laboratory values (WBC, PMN%) and imaging when available 6
Conclusion for Clinical Practice
While Rovsing sign can be a helpful component of the physical examination, clinicians should recognize its limitations and not use it as the sole basis for diagnosis or exclusion of appendicitis. Modern imaging techniques (CT, MRI, ultrasound) provide substantially higher diagnostic accuracy and should be utilized when appendicitis is suspected, especially in equivocal cases.