Morishita et al developed a clinical prediction rule for distinguishing acute appendicitis from pelvic inflammatory disease (PID) in a woman of child-bearing age. The authors are from Okinawa Hokubu Hospital, Okinawa Chubu Hospital, University of Florida Gainesville, University of Hawaii and St. Luke’s Life Science Institute in Tokyo.
Patient selection: female of child-bearing age (12 to 58 years of age) with abdominal pain
Parameters:
(1) migration of pain
(2) abdominal tenderness
(3) nausea and vomiting
|
Migration of Pain |
Tenderness |
Nausea and Vomting |
Appendicitis |
|
present |
bilateral |
NA |
intermediate risk |
|
present |
not bilateral |
NA |
high risk |
|
absent |
bilateral |
absent |
low risk |
|
absent |
bilateral |
present |
intermediate risk |
|
absent |
right-sided |
absent |
intermediate risk |
|
absent |
right-sided |
present |
high risk |
|
absent |
left-sided |
NA |
NA |
|
absent |
none |
NA |
NA |
where:
• Left-sided tenderness and absence of tenderness were not included in the rule.
The assumption is that the risk for PID is the opposite to the risk for appendicitis. Thus PID is most likely if there is no migration of pain, bilateral tenderness and no nausea or vomiting.
Performance:
• The authors claim that the low-risk vs other risk groups was 99% sensitive and 34% specific for PID.
• The assumption is that the diagnosis was PID or appendicitis but there are other causes of abdominal pain.
Purpose: To evaluate a woman of childbearing age with abdominal pain for acute appendicitis vs pelvic inflammatory disease (PID).
Specialty: Gastroenterology, Pedatrics, Surgery, general
Objective: differential diagnosis and mimics, red flags
ICD-10: K35, K36, K37, N70-N77,
