Journal of Current Surgery, ISSN 1927-1298 print, 1927-1301 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Curr Surg and Elmer Press Inc
Journal website http://www.currentsurgery.org

Original Article

Volume 3, Number 1, June 2013, pages 13-18


Clinical Indicators for Differential Diagnosis of Acute Lower Abdominal Pain in Women of Reproductive Age

Tables

Table 1. Demographic Characteristic and Clinical Findings of Patients With Appendicitis, Obstetrics-Gynecological Conditions (OB-GYN), and Non-Specific Abdominal Pain (NSAP)
 
CharacteristicsAppendicitis (n = 382)OB-GYN (n = 97)NSAP (n = 63)P-value
n%n%n%
* Kruskal-Wallis equality-of-populations rank test.
Age (yr)
  > 2516944.24142.32742.9
  Mean (SD)30.1(11.3)28.9(8.8)29.9(10.4)0.937*
Single19350.84951.03353.20.943
Duration of pain (hr)
  > 249424.63940.22133.3
  Mean (SD)31.2(32.0)52.4(65.9)34.9(37.4)0.413*
Shifting of pain14231.266.21117.5< 0.001
Anorexia4311.322.169.50.010
Nausea and vomiting20052.41515.52031.8< 0.001
Abnormal vaginal bleeding10.12828.923.2< 0.001
Diarrhea297.644.11320.60.002
Temperature ≥ 37.5 °C12433.31414.61219.4< 0.001
Pulse rate (/min)(n = 374)(n = 97)(n = 62)
  Tachycardia (≥ 100)11530.62424.71016.3
  Mean (SD)90.8(15.5)88.0(17.4)85.2(17.0)0.021
Systolic blood pressure (mmHg)(n = 374)(n = 97)(n = 61)
  Hypotension (< 90)41.11212.411.6
  Mean (SD)121.8(15.9)112.4(18.5)117.9(14.3)< 0.001
RLQ tender37497.97173.25384.1< 0.001
LLQ tender153.94849.569.5< 0.001
Guarding/rebound tenderness25566.83435.11320.6< 0.001
Hematocrit (%)(n = 336)(n = 86)(n = 55)
  Mean (SD)38.0(3.9)33.3(6.0)36.5(5.9)< 0.001*
WBC (/mm3)(n = 292)(n = 71)(n = 53)
  ≥ 10,00024583.94259.21935.9
  Mean (SD)14,204.5(4,638.4)11,875.9(4,531.9)9,958.8(5,200.0)< 0.001*
Neutrophil (%)(n = 281)(n = 69)(n = 51)
  ≥ 7517160.93956.51019.6< 0.001
Pregnancy71.84748.534.8< 0.001

 

Table 2. Likelihood Ratio of Positive Test (LR+) of Diagnostic Indicators From Multivariable Analysis
 
IndicatorsAppendicitisObstetric-gynecological conditionsNon-specific abdominal pain
LR+ (95%CI)PLR+ (95%CI)PLR+ (95%CI)P
Age > 25yr1.07 (0.91 - 1.26)0.3951.09 (0.68 - 1.76)0.7110.71 (0.33 - 1.53)0.379
Single0.95 (0.80 - 1.12)0.5421.34 (0.84 - 2.14)0.2161.06 (0.49 - 2.30)0.884
Duration of pain > 24 hr1.11 (0.94 - 1.31)0.2370.86 (0.51 - 1.44)0.5670.89 (0.50 - 1.57)0.677
Shifting of pain1.13 (0.99 - 1.28)0.0680.36 (0.13 - 0.99)0.0470.76 (0.35 - 1.68)0.501
Anorexia0.98 (0.81 - 1.17)0.7920.34 (0.13 - 0.88)0.0271.66 (0.69 - 4.00)0.258
Nausea and vomiting1.06 (0.93 - 1.19)0.3750.42 (0.23 - 0.76)0.0040.90 (0.50 - 1.63)0.728
Abnormal vaginal bleeding0.23 (0.03 - 1.51)0.1251.15 (0.56 - 2.39)0.7010.24 (0.03 - 2.30)0.217
Diarrhea0.84 (0.63 - 1.10)0.2070.85 (0.32 - 2.25)0.7382.93 (1.55 - 5.56)0.001
Temperature ≥ 37.5 °C1.00 (0.88 - 1.14)0.9550.71 (0.38 - 1.33)0.2821.06 (0.54 - 2.06)0.863
Tachycardia0.95 (0.83 - 1.09)0.4411.05 (0.61 - 1.81)0.8521.22 (0.62 - 2.43)0.565
Systolic BP ≤ 90 mmHg0.88 (0.33 - 2.31)0.7922.08 (0.82 - 5.29)0.1240.78 (0.10 - 6.07)0.816
RLQ tender2.30 (1.17 - 4.51)0.0160.53 (0.31 - 0.93)0.0260.75 (0.31 - 1.82)0.528
LLQ tender0.22 (0.10 - 0.48)< 0.0013.59 (2.27 - 5.66)< 0.0010.79 (0.30 - 2.13)0.647
Guarding/rebound tenderness1.25 (1.10 - 1.43)0.0010.69 (0.42 - 1.12)0.1310.37 (0.19 - 0.71)0.003
Hematocrit < 33%0.84 (0.65 - 1.09)0.1901.61 (0.87 - 2.98)0.1260.98 (0.43 - 2.23)0.960
WBC ≥ 10,000/mm31.74 (1.38 - 2.20)< 0.0010.38 (0.20 - 0.74)0.0040.36 (0.20 - 0.67)0.001
Neutrophil ≥ 75%1.00 (0.88 - 1.15)0.9561.96 (1.11 - 3.45)0.0210.33 (0.16 - 0.66)0.002
Pregnancy0.31 (0.14 - 0.69)0.0042.24 (1.18 - 4.25)0.0141.18 (0.32 - 4.29)0.806

 

Table 3. Summarized Direction of Likelihood of Diagnosis (Appendicitis, Common Obstetric and Gynecological Conditions; OB-GYN, or Non-Specific Abdominal Pain; NSAP) for Each Clinical Indicators
 
Diagnostic indicatorsLikelihood of diagnosis
AppendicitisOB-GYNNSAP
AnorexiaDecrease
Nausea/vomitDecrease
Shifting of painDecrease
DiarrheaIncrease
RLQ tenderIncreaseDecrease
LLQ tenderDecreaseIncrease
Guarding/rebound tendernessIncreaseDecrease
PregnancyDecreaseIncrease
WBC ≥ 10,000/mm2IncreaseDecreaseDecrease
Neutrophil ≥ 75%IncreaseDecrease