Acute appendicitis is the most common non-gynecological emergency during pregnancy. The diagnosis of appendicitis during pregnancy is challenging due to both physiological and laboratory changes. As such, the surgeon needs additional guidance, other than imaging methods, before deciding a surgical intervention. Various scoring methods have been defined and evaluated for the diagnosis of acute appendicitis for a long time. There is no definition of a score for the gestation period, and the comparison of the currently applied scoring methods during the gestation period is not available in the literature.
The purpose of our study is to evaluate the efficacy of the most popular scoring systems applied in the diagnosis of acute appendicitis in pregnancy and the tips for introduction to a scoring method for the pregnancy period.
This single-center retrospective study consists of 79 pregnant patients who were admitted to the emergency department with abdominal pain between May 2014, May 2019 and were diagnosed with acute appendicitis and underwent an appendectomy together with 79 non-pregnant control group who underwent appendectomy for the last 1.5 years. Both laboratory and examination findings required for the scoring methods of the patients were obtained and calculated separately for each patient. Negative appendectomy rates were evaluated according to pathology results. Categorical variables were compared by the Chi-Square test. Categorical variables were presented as a count and percentage. A p-value <0.05 was considered significant. Receiver operator characteristic (ROC) curve analysis was used to identify the best cut-off value and assess the performance of the test score for appendicitis.
The Tzanakis Score is the strongest among the scoring systems used in non-pregnant women. The positive predictive value (PPV = 90.60) of the Tzanakis Score is 90.6% while the negative predictive value (NPV = 46.7) is 46.7%. RIPASA seems to be the strongest among the scoring systems used in pregnant women. While PPV of this scoring method is 94.40%, NPV is 44%, its sensitivity and specificity are 78.46% and 78.57%, respectively.
Although the RIPASA score is considerable effective in pregnancy in the diagnosis of acute appendicitis among all scoring systems, a specific scoring system is necessitated for the gestation period.