title: The diagnostic performance of ultrasound for acute appendicitis in pregnant and young nonpregnant women: A case-control study.
abstract: BACKGROUND
  Ultrasonography is frequently used to diagnose acute appendicitis in women of reproductive age, but its diagnostic value in pregnant patients remains unclear. This study sought to compare the diagnostic performance of ultrasound in pregnant and young nonpregnant women with suspected acute appendicitis.
  
  
  METHODS
  The database of a single tertiary medical center was reviewed for all women of reproductive age who underwent appendectomy either during pregnancy (2000-2014) or in the nonpregnant state (2004-2007) following ultrasound evaluation. The performance of ultrasound in terms of predicting the final pathologic diagnosis was compared between the pregnant and non pregnant groups using receiver operating characteristic curve analysis.
  
  
  RESULTS
  Of 586 young women treated for appendicitis during the study periods (92 pregnant, 494 non-pregnant), 200 underwent preoperative ultrasound [67 pregnant, and 133 nonpregnant young women]. The pregnant and nonpregnant groups were comparable in age and presenting symptoms. There was no significant difference in the predictive performance of ultrasound between the two groups (AUC 0.76 and 0.73 respectively, p = 0.78) or within the pregnant group, by trimester [first (n = 23), AUC 0.73; second (n = 32), AUC 0.67; third (n = 12), AUC 0.86; p = 0.4]. Ultrasound had a positive predictive value of 0.94 in the pregnant group and 0.91 in the nonpregnant group; corresponding negative predictive values were 0.40 and 0.43.
  
  
  CONCLUSIONS
  There appears to be no difference in the ability of ultrasound to predict the diagnosis of acute appendicitis between pregnant women and nonpregnant women of reproductive age. Therefore, similar preoperative imaging algorithms may be used in both patient populations.
authors.affiliation: Department of General Surgery and Oncological Surgery - Surgery C, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: lior.segev@sheba.health.gov.il.
authors.forename: Lior
authors.initials: L
authors.lastname: Segev
authors.affiliation: Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Israel Institute of Technology, Haifa, Israel.
authors.forename: Yakir
authors.initials: Y
authors.lastname: Segev
authors.affiliation: Department of General Surgery and Oncological Surgery - Surgery C, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Shlomi
authors.initials: S
authors.lastname: Rayman
authors.affiliation: Department of General Surgery and Oncological Surgery - Surgery C, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Aviram
authors.initials: A
authors.lastname: Nissan
authors.affiliation: Department of Surgery, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Sadot
mesh_terms: D000208:Acute Disease; D000328:Adult; D000465:Algorithms; D001062:Appendectomy; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000601:surgery; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging* / Q000601:surgery; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods*
keywords: Appendicitis; Pregnancy; Ultrasound