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

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.