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. 2022 Oct 23;23(6):913-918.
doi: 10.5811/westjem.2022.8.56638.

Accuracy of Point-of-care Ultrasound in Diagnosing Acute Appendicitis During Pregnancy

Désirée Abgottspon  1 , Katharina Putora  1 , Janis Kinkel  1 , Kinga Süveg  2 , Bernhard Widmann  3 , René Hornung  1 , Bruno Minotti  4   5
Affiliations

Accuracy of Point-of-care Ultrasound in Diagnosing Acute Appendicitis During Pregnancy

Désirée Abgottspon et al. West J Emerg Med. .

Abstract

Introduction: Acute appendicitis is the most common non-obstetrical surgical emergency in pregnancy. Ultrasound is the imaging tool of choice, but its use is complicated due to anatomical changes during pregnancy and depends on the clinician's expertise. In this study, our aim was to investigate the diagnostic accuracy of point-of-care ultrasound (POCUS) in suspected appendicitis in pregnant women.

Methods: We conducted a retrospective analysis of all pregnant women undergoing POCUS for suspected appendicitis between June 2010-June 2020 in a tertiary emergency department. The primary outcome was to establish sensitivity, specificity, and likelihood ratios of POCUS in diagnosing acute appendicitis, overall and for each trimester. We used histology of the appendix as the reference standard in case of surgery. If appendectomy was not performed, the clinical course until childbirth was used to rule out appendicitis. If the patients underwent magnetic resonance imaging (MRI), we compared readings to POCUS.

Results: A total of 61 women were included in the study, of whom 34 (55.7%) underwent appendectomy and in 30 (49.2%) an acute appendicitis was histopathologically confirmed. Sensitivity of POCUS was 66.7% (confidence interval [CI] 95% 47.1-82.7), specificity 96.8% (CI 95% 83.3-99.9), and positive likelihood ratio 20.7. Performance of POCUS was comparable in all trimesters, with highest sensitivity in the first trimester (72.7%). The MRI reading showed a sensitivity of 84.6% and a specificity of 100%. In the four negative appendectomies a MRI was not performed.

Conclusion: Point-of-care ultrasound showed a high specificity and positive likelihood ratio in diagnosing acute appendicitis in pregnant women in all trimesters with suspected appendicitis. In negative (or inconclusive) cases further imaging as MRI could be helpful to avoid negative appendectomy.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1
Figure 1
Patients’ inclusion flow chart and diagnostic STARD pathway. *Due to clinical deterioration both patients had an additional imaging study (one ultrasound, one magnetic resonance imaging) one day later, both with positive results. These two patients underwent surgery with histologically confirmed acute appendicitis. STARD, Standards for Reporting Diagnostic Accuracy; MRI, magnetic resonance imaging.
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