title: Factors predicting significant pathology on ultrasonography in women presenting with non-specific lower abdominal pain.
abstract: BACKGROUND
  Ultrasonography is used frequently to exclude significant pathology in young women presenting with non-specific lower abdominal pain (NSLAP). This study examined parameters that predicted the likelihood of significant findings on ultrasonography. These results could be used to select patients for priority imaging or identify those who could be managed with no ultrasonography.
  
  
  METHODS
  A total of 65 women with NSLAP were identified from 283 admissions. Group 1 (n=42) consisted of patients with normal imaging. Group 2 (n=23) included patients with 'positive' scans requiring treatment. White cell count (WCC), C-reactive protein (CRP) levels, platelet count, age, duration of pain and length of stay in hospital were compared between the groups.
  
  
  RESULTS
  The median WCC and CRP were greater in Group 2 than in Group 1: 15 x 10(9)/l and 123 mg/l versus 11 x 10(9)/l and 72 mg/l respectively (p=0.01 and p=0.05). CRP was a weak predictor of positive pathology on ultrasonography (area under curve [AUC]=0.66, p=0.027) and WCC was a strong predictor of abnormal pathology on ultrasonography (AUC=0.7, p=0.005). A WCC of >12.8 x 10(9)/l was 65% sensitive and 71% specific in predicting subsequent pathology on ultrasonography. The median wait for ultrasonography was 24 hours (range: 1-96 hours).
  
  
  CONCLUSIONS
  This study failed to define any criteria that could select patients not requiring ultrasonography. Since ultrasonography is a relatively cheap and safe investigation, its continued use to screen women with NSLAP is justified. WCC should be used to prioritise imaging.
authors.affiliation: University Hospitals of Leicester NHS Trust, UK. dilrajbilku@yahoo.co.uk
authors.forename: D K
authors.initials: DK
authors.lastname: Bilku
authors.forename: T C
authors.initials: TC
authors.lastname: Hall
authors.forename: A R
authors.initials: AR
authors.lastname: Dennison
authors.forename: M S
authors.initials: MS
authors.lastname: Metcalfe
authors.forename: G
authors.initials: G
authors.lastname: Garcea
mesh_terms: D015746:Abdominal Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D007902:Length of Stay; D007958:Leukocyte Count; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein