J Korean Soc Emerg Med.  2016 Dec;27(6):586-594. 10.0000/jksem.2016.27.6.586.

Diagnostic Efficacy of the Modified Alvarado Score for Acute Appendicitis in Pregnant Women

• Kim CS
• Park HI
• Lee JH
• Jung WH
• Lee SH
• Nho WY
• Kim SH
• Je DW
• Choe MS
• Lee JY
• Bae JK
• Je SM
• Chung TN
• Kim EC
• Choi SW
• Kim OJ

• KMID: 2369047
• DOI: http://doi.org/10.0000/jksem.2016.27.6.586

Abstract

PURPOSE
We aimed to evaluate whether the modified Alvarado score-which is currently being used to diagnose acute appendicitis-can be applicable in the diagnosis of diseases in pregnant women.
METHODS
We retrospectively analyzed the medical records of 252 pregnant women who visited our emergency department (ED) with a chief complaint of abdominal pain and a suspicion of acute appendicitis, and ultimately underwent appendix ultrasonography or appendix magnetic resonance imaging (MRI). The modified Alvarado score was calculated for each pregnant woman. A receiver operating characteristic (ROC) curve was drawn for each subject, those in the first trimester, second trimester, and third trimester, from which the best cut-off value, sensitivity and specificity were induced.
RESULTS
For all 252 pregnant women who visited our ED, the area under the curve was 0.742 (p<0.001), with sensitivity and specificity of 75.41% and 62.30%, respectively, when using the value of 5 as the cut-off point for the modified Alvarado score. The area under the curve was 0.811 (p<0.001) for those in their first trimester and 0.749 (p<0.001) for those in the second trimester, while it was 0.641, with the p-value of 0.109, for those in the third trimester.
CONCLUSION
There is a limitation using the modified Alvarado score alone in pregnant woman, and if there is uncertainty in the diagnosis, other imaging studies, such as appendix ultrasonography or appendix MRI, should be considered.

Keyword

Appendicitis; Pregnancy; Trimester; ROC curve

MeSH Terms

Abdominal Pain
Appendicitis*
Appendix
Diagnosis
Emergency Service, Hospital
Female
Humans
Magnetic Resonance Imaging
Medical Records
Pregnancy
Pregnancy Trimester, First
Pregnancy Trimester, Second
Pregnancy Trimester, Third
Pregnant Women*
Retrospective Studies
ROC Curve
Sensitivity and Specificity
Ultrasonography
Uncertainty