Bubble bubble, abdominal trouble: a new test to chew on.

A ppendicitis, acute pancreatitis, diverticulitus: all possible serious diagnoses in patients presenting to the emergency department with abdominal pain. The diagnosis of these and other generalized or localized irritations of the peritoneum is sometimes based on the physician's " gut feelings " but are more commonly the result of diagnostic tests. A number of such tests have been proposed to exclude peritonitis or any serious acute abdominal pathology. 1–3 At best, these tests have been found to have only modest sensitivity and specificity, and their positive predictive value in the relatively low-prevalence situation of primary care is likely to be poor. In the acute stage, x-rays, urinalysis and blood tests are well known to give mostly negative results. With no reliable diagnostic tool available, we must turn to trailblazers like Wriggley and H. Bubba. We present the results from a pilot study of a new test for the assessment of acute abdominal pain: the 3C-BG (chew, chomp, crack, bubble-blow gum) test. Results are deemed positive if any of the following activities are observed during the examination. • Continued closed-mouth gum chewing throughout the examination (+) (Fig. 1). • Open-mouth gum chomping (++). • Gum cracking, in addition to chewing (+++). • Bubble blowing (++++) (Fig. 2). The presence of a positive result means that the patient does not have a serious illness. Six consecutive patients who presented with abdominal pain to our small emergency department in rural New-foundland, and who were observed by the admitting nurse to be chewing bubble gum, agreed to participate. Two subjects were later excluded: one because, on closer inspection, he was discovered to be chewing tobacco and another because he was clicking his false teeth and did not actually have gum in his mouth. All eligible participants were subjected to routine history-taking and physical examination; laboratory tests and x-rays were ordered as the attending physician (G.W.) felt appropriate. During the history-taking, examination and laboratory testing, all patients were kept under observation, except when they were in the washroom (that's a different study altogether). Of the 4 people eligible for the 3C-BG test, 2 were females and 2 were males. Their ages ranged from 6 to 36 years. All had great breath. We observed 1 chomper, 1 cracker and 2 bubble-blowers. None proved to have a serious abdominal illness. All complained that their bubble gum had lost its flavour. If the 3C-BG test results were positive …