Single institution and statewide performance of ultrasound in diagnosing appendicitis in pregnancy

Abstract

Objective: Assess the performance of ultrasound (US) in pregnant patients presenting with acute abdominal pain concerning for appendicitis.

Methods: Descriptive analysis of pregnant patients who underwent an US for acute abdominal pain over a 6-year period using data from a statewide quality improvement collaborative and a single center.

Results: Statewide, 131 pregnant patients underwent an appendectomy and 85% had an US. In our single-center case series, 49 pregnant patients underwent an US for acute abdominal pain and four patients had appendicitis (8%). Of those, three were definitively diagnosed with US. The appendix was visualized by US in five patients (3 appendicitis/2 normal). Mean gestational age was 11 weeks for visualization of the appendix versus 20 weeks for non-visualization (p < 0.001). Concordance between US and pathology was similar statewide and at our institution (43%).

Conclusions: US appears to play a central role in the evaluation of appendicitis in pregnant women, especially in the first trimester, and often contributes to definitive disposition. US performed less well in excluding appendicitis; however, in certain clinical settings, providers appeared to trust US findings. From these results, we developed a multidisciplinary imaging pathway for pregnant patients who present with acute abdominal pain concerning for appendicitis.

• Appendicitis
• diagnostic imaging
• pregnancy

Acknowledgements

The Comparative Effectiveness Research Translation Network (CERTAIN) is supported by the Life Discovery Fund of Washington State and the Agency for Healthcare Research and Quality (AHRQ). Dr. Kotagal and Dr. Drake are supported by a University of Washington Department of Surgery T32 training fellowship grant from the National Institute of Diabetes & Digestive & Kidney Diseases (grant number 5T32DK070555-03). The administrative home for the Surgical Care and Outcomes Assessment Program (SCOAP) is the Foundation for Healthcare Quality.

This paper has not been previously presented. The authors have no disclaimers.

The authors acknowledge Dr. Michael Gravett for his assistance in editing this manuscript.

Declaration of interest

The authors report no declarations of interest. There was no source of financial support for this research.