Hindawi Publishing Corporation Emergency Medicine International Volume 2013, Article ID 730167, 6 pages http://dx.doi.org/10.1155/2013/730167 Research Article Clinical Scoring for Diagnosis of Acute Lower Abdominal Pain in Female of Reproductive Age Kijja Jearwattanakanok, 1 Sirikan Yamada, 2 Watcharin Suntornlimsiri, 3 Waratsuda Smuthtai, 4 and Jayanton Patumanond 5 1 Department of Surgery, Nakornping Hospital, Chiang Mai 50180, Tailand 2 Division of Gastrointestinal Surgery and Endnoscopy, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Tailand 3 Department of Obstetrics & Gynecology, Nakornping Hospital, Chiang Mai 50180, Tailand 4 Department of Emergency Medicine, Nakornping Hospital, Chiang Mai 50180, Tailand 5 Clinical Epidemiology Unit & Clinical Research Center, Faculty of Medicine, Tammasat University, Pathum Tani 12120, Tailand Correspondence should be addressed to Jayanton Patumanond; j.patumanond@yahoo.com Received 4 August 2013; Revised 17 October 2013; Accepted 31 October 2013 Academic Editor: Christian Wrede Copyright © 2013 Kijja Jearwattanakanok et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Obstetrics and gynecological conditions (OB-GYNc) are difcult to be diferentiated from appendicitis in young adult females presenting with acute lower abdominal pain. Timely and correct diagnosis is clinically challenging. Method. A retrospective data analysis was performed on 542 female patients who were admitted to a tertiary care hospital with a chief complaint of acute lower abdominal pain. Diagnostic indicators of appendicitis and OB-GYNc were identifed by stepwise multivariable polytomous logistic regression. Diagnostic performances of the scores were tested. Result. Te developed clinical score is comprised of (1) guarding or rebound tenderness, (2) pregnancy, (3) sites of abdominal tenderness, (4) leukocytosis, (5) peripheral neutrophils ≥75%, and (6) presence of diarrhea. For diagnosis of appendicitis, the area under the ROC curve was 0.8696, and the sensitivity and specifcity were 89.25% and 70.00%. For OB-GYNc, the corresponding values were 0.8450, 66.67%, and 94.85%, respectively. Conclusion. Te clinical scoring system can diferentiate the diagnosis of acute lower abdominal pain in young adult females. Time spent for diagnosis at the emergency room may be shortened, and the patients would be admitted to the appropriate departments in less time. 1. Introduction Diagnosis of acute lower abdominal pain in young adult female is a clinical challenge. Appendicitis and obstetrics and gynecological conditions (OB-GYNc), such as ectopic preg- nancy, pelvic infammatory diseases, and complicated ovar- ian cyst, are common causes of acute lower abdominal pain in females during reproductive age [1]. Accurate and timely diagnosis of the condition is critical since incorrect diagnosis can lead to improper surgical intervention, and delayed diag- nosis results in delayed management of urgent conditions [2]. Emergency physicians play an important role in early diagnosis and prompt management of the conditions. Expe- rienced emergency physicians can detect important clinical fndings and give a provisional diagnosis to a patient before transferring her to general surgery or obstetrics and gynecol- ogy departments according to their judgment. Previous stud- ies showed that some clinical indicators were helpful to dis- tinguish appendicitis and common obstetrics and gynecolog- ical conditions (OB-GYNc) from nonspecifc abdominal pain (NSAP) [3]. To resolve the difculty in diagnosis of acute lower abdominal pain in female patients, whose appendicitis is con- founded by OB-GYNc, imaging studies had been done. Imag- ing investigations such as ultrasonography, computerized tomography (CT), and magnetic resonance imaging (MRI) have high accuracies in diagnosis of acute lower abdominal pain [4, 5]. However, the universal usage of CT may not be