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J Korean Soc Emerg Med > Volume 27(6); 2016 > Article
Journal of The Korean Society of Emergency Medicine 2016;27(6): 586-594.
산모 급성 충수염에서 Modified Alvarado 점수의 진단적 가치
김철수1, 박홍인2, 이중호1, 정운혁1, 이수형1, 노우영2, 김성훈2, 제동욱2, 최마이클승필2, 이준영1, 배진건1, 제상모1, 정태녕1, 김의중1, 최성욱1, 김옥준1
1차의과학대학교 분당차병원 응급의학과
2구미차병원 응급의학과
Diagnostic Efficacy of the Modified Alvarado Score for Acute Appendicitis in Pregnant Women
Chul Soo Kim1, Hong In Park2, Jung Ho Lee1, Woon Hyuk Jung1, Soo Hyung Lee1, Woo Young Nho2, Seong Hun Kim2, Dong Wook Je2, Michel Sung Pil Choe2, June Young Lee1, Jin Kun Bae1, Sang Mo Je1, Tae Nyoung Chung1, Eui Chung Kim1, Sung Wook Choi1, Ok Jun Kim1
1Department of Emergency Medicine, CHA Bundang Medical Center, Seongnam, CHA University, Korea
2CHA Gumi Medical Center, Gumi, CHA University, Korea
Correspondence  Hong In Park ,Tel: 054-450-9997, Fax: 054-450-9886, Email: twilgiht2002@naver.com,
Received: June 14, 2016; Revised: June 16, 2016   Accepted: August 27, 2016.  Published online: December 31, 2016.
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.
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.
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.
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.
Key words: Appendicitis, Pregnancy, Trimester, ROC curve
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