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Positive predictive value of Carnett’s sign in differential diagnosis of chronic abdominal pain: a retrospective cohort study

      Chronic abdominal pain, either originates from abdominal wall (somatic pain) or intra-abdominal cavity (visceral pain), may become a debilitating clinical condition. It is important clinically to differentiate between these two distinctive origins as the treatment strategies can be different. In acute abdominal pain, Carnett’s sign has been established as a simple but useful physical examination for differential diagnosis. A positive Carnett’s sign suggests likely abdominal wall pain and a negative sign suggests likely visceral pain. However, chronic abdominal pain is much different from acute abdominal pain in many aspects, therefore the clinical value of Carnett’s sign in chronic abdominal pain remains to be elucidated. In this retrospective cohort study, we have identified over fifty patients between 2011 and 2012, whom have been treated for abdominal pain in our pain clinic. We have compared the final diagnoses (abdominal wall pain vs. visceral pain) with the initial physical examination findings, and analyzed the positive predictive value of Carnett’s sign. We believe this study will help us to better understand and approach chronic abdominal pain.