Rovsing sign revisited - Effects of an erroneous translation on medical teaching and research

Objective To investigate whether Rovsing sign in the diagnosis of appendicitis is described and applied inaccurately in the current literature, scientific papers, and books; quantify the problem; and investigate the cause of this error. Background The method of eliciting Rovsing sign is not described uniformly throughout the literature. Methods PubMed, MEDLINE, and Embase searches were conducted, and 1178 individual studies were searched for the use of Rovsing sign. A total of 57 studies were included in this study; of these, 14 described the way that the sign was executed. Additionally, 3 current English (text)books on surgery, 3 German (text)books on surgery, and 3 German books on anatomy were analyzed. The descriptions in studies and books were compared with the original publication by Niels Thorkild Rovsing in 1907. Results No included study that described the method of eliciting Rovsing sign provided a correct description. None of the 3 English (text)books on surgery described the sign accurately, but all 6 German (text)books provided a correct description. Conclusion Rovsing sign is used erroneously in clinical practice and medical research and is most likely already taught incorrectly to most medical students. All statistical data available on this sign must be questioned and reinvestigated in future well-designed studies to assess the actual value of Rovsing sign in the diagnosis of appendicitis.