Clinical prediction rule to distinguish pelvic inflammatory disease from acute appendicitis in women of childbearing age.
OBJECTIVE
We aimed to develop a clinical prediction rule to distinguish pelvic inflammatory disease (PID) from acute appendicitis in women of childbearing age.


METHODS
We reviewed medical records over a 4-year period of female patients of childbearing age who had presented with abdominal pain at an urban emergency department and had either appendicitis (n = 109) or PID (n = 72). A prediction rule was developed by use of recursive partitioning based on significant factors for the discrimination.


RESULTS
The significant factors to favor PID over appendicitis were (1) no migration of pain (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.5-11.5), (2) bilateral abdominal tenderness (OR, 16.7; 95% CI, 5.3-50.0), and (3) absence of nausea and vomiting (OR, 8.4; 95% CI, 2.8-24.8). The prediction rule could rule out appendicitis from PID with sensitivity of 99% (95% CI, 94-100%) when classified as a low-risk group by the following factors: (1) no migration of pain, (2) bilateral abdominal tenderness, and (3) no nausea and vomiting.


CONCLUSIONS
We developed a prediction rule for childbearing-aged women presenting with acute abdominal pain to distinguish acute appendicitis from PID based on 3 simple, clinical features: migration of pain, bilateral abdominal tenderness, and nausea and vomiting. Prospective validation is needed in other settings.
Morishita
Koji
K
Department of Surgery, Okinawa Hokubu Hospital, Okinawa, Japan. morishita_koji@hosp.pref.okinawa.jp
Gushimiyagi
Masanori
M
Hashiguchi
Mikio
M
Stein
Gerald H
GH
Tokuda
Yasuharu
Y
D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D003661:Decision Support Techniques; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D000292:Pelvic Inflammatory Disease / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors