Current Diagnosis and Scoring Systems

Emergency physicians play an important role in early diagnosis and prompt management of the conditions. Experienced emergency physicians can detect important clinical findings and give a provisional diagnosis to a patient before transferring her to general surgery or obstetrics and gynecology departments according to their judgment. Previous studies showed that some clinical indicators were helpful to distinguish appendicitis and common obstetrics and gynecological conditions (OB-GYNc) from nonspecific abdominal pain. To resolve the difficulty in diagnosis of acute lower abdominal pain in female patients, whose appendicitis is confounded by OB-GYNc, imaging studies had been done. Imaging investigations such as ultrasonography, computerized tomography (CT), and magnetic resonance imaging (MRI) have high accuracies in diagnosis of acute lower abdominal pain. However, the universal usage of CT may not be cost-effective in countries with limited healthcare resources. In addition, time spent for such investigations is also important for the emergency department. Clinical diagnostic scoring, on the other hand, may be more appropriate for early diagnosis in an emergency department setting. Clinical scoring for diagnosis of appendicitis was studied for its application as a guideline used for admission and investigations. However, such clinical scoring system was not designed for diagnosis of acute lower abdominal pain from obstetrics and gynecology conditions (OB-GYNc), which are also important in young adult females. Precise and systematic pain assessment is required to make the correct diagnosis and determine the most efficacious treatment plan for patients presenting with pain.