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Lateralization and Bodily Patterns of Segmental Signs and Spontaneous Pain in Acute Visceral Disease: Observational Study

Shaballout, N. and Aloumar, A. and Manuel, J. and May, M. and Beissner, F. (2021) Lateralization and Bodily Patterns of Segmental Signs and Spontaneous Pain in Acute Visceral Disease: Observational Study. Journal of Medical Internet Research, 23 (8), e27247. JMIR Publications. doi: 10.2196/27247. ISSN 1439-4456.

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Official URL: http://dx.doi.org/10.2196/27247

Abstract

Background: The differential diagnosis of acute visceral diseases is a challenging clinical problem. Older literature suggests that patients with acute visceral problems show segmental signs such as hyperalgesia, skin resistance, or muscular defense as manifestations of referred visceral pain in somatic or visceral tissues with overlapping segmental innervation. According to these sources, the lateralization and segmental distribution of such signs may be used for differential diagnosis. Segmental signs and symptoms may be accompanied by spontaneous (visceral) pain, which, however, shows a nonsegmental distribution. Objective: This study aimed to investigate the lateralization (ie, localization on one side of the body, in preference to the other) and segmental distribution (ie, surface ratio of the affected segments) of spontaneous pain and (referred) 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 considered by triage as related to internal organ disease. All patients underwent a structured 10-minute bodily examination to test for various segmental signs and spontaneous visceral pain. They were further asked their segmental symptoms such as nausea, meteorism, and urinary retention. We collected spontaneous pain and segmental signs as digital drawings and segmental symptoms as binary values on a tablet PC. After the final diagnosis, patients were divided into groups according to the organ affected. Using statistical image analysis, we calculated mean distributions of pain and segmental signs for the heart, lungs, stomach, liver/gallbladder, and kidneys/ureters, analyzing the segmental distribution of these signs and the lateralization. Results: Of the 208 recruited patients, 110 (52.9%) were later diagnosed with a single-organ problem. These recruited patients had a mean age of 57.3 (SD 17.2) years, and 40.9% (85/208) were female. Of these 110 patients, 85 (77.3%) reported spontaneous visceral pain. Of the 110, 81 (73.6%) had at least 1 segmental sign, and the most frequent signs were hyperalgesia (46/81, 57%), and muscle resistance (39/81, 48%). While 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 (37/110, 33.6%) further showed ipsilateral mydriasis. Conclusions: This study underlines the usefulness of including digitally recorded segmental signs in bodily examinations of patients with acute medical problems.

Item URL in elib:https://elib.dlr.de/144620/
Document Type:Article
Title:Lateralization and Bodily Patterns of Segmental Signs and Spontaneous Pain in Acute Visceral Disease: Observational Study
Authors:
AuthorsInstitution or Email of AuthorsAuthor's ORCID iDORCID Put Code
Shaballout, N.Somatosensory and Autonomic Therapy Research, Institute for Neuroradiology, Hannover Medical School, Hannover , DEUNSPECIFIEDUNSPECIFIED
Aloumar, A.Somatosensory and Autonomic Therapy Research, Institute for Neuroradiology, Hannover Medical School, Hannover , DEUNSPECIFIEDUNSPECIFIED
Manuel, J.Somatosensory and Autonomic Therapy Research, Institute for Neuroradiology, Hannover Medical School, Hannover , DE and Institute of Aerospace Medicine, German Aerospace Centre , Cologne, GermanyUNSPECIFIEDUNSPECIFIED
May, M.Somatosensory and Autonomic Therapy Research, Institute for Neuroradiology, Hannover Medical School, Hannover , DEUNSPECIFIEDUNSPECIFIED
Beissner, F.Somatosensory and Autonomic Therapy Research, Institute for Neuroradiology, Hannover Medical School, Hannover , DEUNSPECIFIEDUNSPECIFIED
Date:23 August 2021
Journal or Publication Title:Journal of Medical Internet Research
Refereed publication:Yes
Open Access:Yes
Gold Open Access:Yes
In SCOPUS:Yes
In ISI Web of Science:Yes
Volume:23
DOI:10.2196/27247
Page Range:e27247
Publisher:JMIR Publications
ISSN:1439-4456
Status:Published
Keywords:digital pain drawings; visceral referred pain; referred pain; head zones; mydriasis; chest pain; clinical examination; differential diagnosis; digital health; digital drawings; pain; health technology; image analysis
HGF - Research field:Aeronautics, Space and Transport
HGF - Program:Space
HGF - Program Themes:Research under Space Conditions
DLR - Research area:Raumfahrt
DLR - Program:R FR - Research under Space Conditions
DLR - Research theme (Project):R - CardioBrain
Location: Köln-Porz
Institutes and Institutions:Institute of Aerospace Medicine
Institute of Aerospace Medicine > Cardiovascular Medicine in Aerospace
Deposited By: Schrage, Larissa
Deposited On:21 Oct 2021 13:09
Last Modified:21 Oct 2021 13:09

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