A Model for Prediction of Pelvic Inflammatory Disease and Acute Appendicitis in Childbearing-aged Women who Visit the Emergency Department with Abdominal Pain

ABSTRACT

PURPOSE: We evaluated important factors for pelvic inflammatory disease (PID) and acute appendicitis, respectively, and we developed scoring systems for use in screening for PID or acute appendicitis in childbearing-aged women who visit the emergency department (ED) with abdominal pain. METHODS: By performance of multivariable logistic regression analysis, we found statistically significant factors for PID and acute appendicitis in prospectively collected registries, and we developed scoring systems for screening of each disease. The performances of these scoring systems were compared using the area under the receiver operating characteristics (ROC) curve. RESULTS: A total of 1048 patients were registered. Among them, 279 patients diagnosed as PID (155 patients) or acute appendicitis (124 patients) were finally analyzed in this study. The significant factors that favored PID were a length of pain onset more than two days, a history of coitus within four weeks, fever, a history of abortion, vaginal secretions, taking a painkiller for dysmenorrhea, diffuse low abdominal tenderness, no migration of pain, absence of gastrointestinal symptoms, and no leukocytosis. The significant factors that favored acute appendicitis were directly contrary to the significant factors for PID. Each of these variables was assigned a score of 1 or 2. The ROC areas of PID and acute appendicitis were 0.896 and 0.910, respectively. CONCLUSION: In order to screen for PID and acute appendicitis, among other diseases, using eleven important factors, we developed scoring systems for childbearing-aged women who present with abdominal pain. Conduct of further prospective study that will utilize these scoring systems is needed.