3 clinical features distinguish PID from appendicitis
Clinical QuestionWhat clinical variables help distinguish pelvic inflammatory disease from acute appendicitis in women?
Bottom LineIn this poorly described study, a clinical decision rule consisting of 3 variables helped distinguish appendicitis from pelvic inflammatory disease (PID) in women of childbearing age: no pain migration; bilateral tenderness; and no nausea and vomiting. This rule needs to be validated. (LOE = 3b)
ReferenceMorishita K, Gushimiyagi M, Hashiguchi M, Stein GH, Tokuda Y. Clinical prediction rule to distinguish pelvic inflammatory disease from acute appendicitis in women of childbearing age. Am J Emerg Med 2007;25:152-157. [PMID:17276803]
Study DesignDecision rule (development only)
SynopsisThese authors retrospectively assessed the medical records of 181 consecutive women between the ages of 12 years and 58 years of age presenting to the emergency department for the evaluation of acute abdominal pain. They don't describe how they extracted the data from the medical records or if the original clinical information was collected in a standard fashion or if the final diagnoses were made using standardized criteria. The final diagnosis of appendicitis was determined by histopathologic findings. PID was established using the Centers for Disease Control's minimum criteria: lower abdominal tenderness, adnexal tenderness, and cervical motion tenderness. Three clinical factors were more likely to be associated with a low risk of appendicitis: no pain migration; bilateral tenderness; no nausea and vomiting. Combining these into a prediction model was 99% sensitive (95% CI, 94.4-99.9) for ruling out appendicitis, but only 33.9% specific (23.1-46.6). The positive likelihood ratio was 1.5 (1.25-1.80) and the negative likelihood ratio was 0.03 (.004-.22). This means the clinical criteria were very good at ruling out appendicitis but not good at ruling it in.
Barry, Henry, et al., editors. "3 Clinical Features Distinguish PID From Appendicitis." EE+ POEM Archive, John Wiley & Sons, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/infoPOEMs/426638/all/3_clinical_features_distinguish_PID_from_appendicitis.
3 clinical features distinguish PID from appendicitis. In: Barry HH, Ebell MHM, Shaughnessy AFA, et al, eds. EE+ POEM Archive. John Wiley & Sons; 2019. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426638/all/3_clinical_features_distinguish_PID_from_appendicitis. Accessed June 3, 2023.
3 clinical features distinguish PID from appendicitis. (2019). In Barry, H., Ebell, M. H., Shaughnessy, A. F., & Slawson, D. C. (Eds.), EE+ POEM Archive. John Wiley & Sons. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426638/all/3_clinical_features_distinguish_PID_from_appendicitis
3 Clinical Features Distinguish PID From Appendicitis [Internet]. In: Barry HH, Ebell MHM, Shaughnessy AFA, Slawson DCD, editors. EE+ POEM Archive. John Wiley & Sons; 2019. [cited 2023 June 03]. Available from: https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426638/all/3_clinical_features_distinguish_PID_from_appendicitis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - 3 clinical features distinguish PID from appendicitis ID - 426638 ED - Barry,Henry, ED - Ebell,Mark H, ED - Shaughnessy,Allen F, ED - Slawson,David C, BT - EE+ POEM Archive UR - https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426638/all/3_clinical_features_distinguish_PID_from_appendicitis PB - John Wiley & Sons DB - Evidence Central DP - Unbound Medicine ER -