Air Score Assessment for Acute Appendicitis

Von-Mühlen, Bruno; Franzon, Orli; Beduschi, Murilo Gamba; Kruel, Nicolau Fernandes; Lupselo, Daniel

doi:10.1590/s0102-67202015000300006

Cited by 26 publications

(24 citation statements)

References 9 publications

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“…[14] It is similar to the modifi ed Alvarado and RIPASA in that the AIR score can be calculated from the clinical parameters and two important laboratory investigations (leucocytosis and C-reactive protein). [14,15] The AIR score has a minimum value of five and a maximum value of 12, and it is presumed to assess the severity of acute appendicitis in relation to leucocytosis, the C-reactive protein and segmented neutrophils. [15] In addition, the AIR score has shown better results than the Alvarado score, [16] which yielded a value greater than four and a sensitivity and specificity of 97% and 77%, respectively, [16] whereas the AIR score had a value greater than 8 and yielded a sensitivity and specifi city of 12% and 100%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis

Shuaib

Fakhra

et al. 2017

World Journal of Emergency Medicine

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BACKGROUND: Acute appendicitis is the most common surgical condition presented in emergency departments worldwide. Clinical scoring systems, such as the Alvarado and modified Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%-10%. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specifi cally for Asian populations. The aim of this study was to compare the modifi ed Alvarado with the RIPASA scoring system in Kuwait population. METHODS:This study included 180 patients who underwent appendectomies and were documented as having "acute appendicitis" or "abdominal pain" in the operating theatre logbook (unit B) from November 2014 to March 2016. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic (ROC) curve of the modified Alvarado and RIPASA scoring systems were derived using SPSS statistical software. RESULTS:A total of 136 patients were included in this study according to our criteria. The cut-off threshold point of the modifi ed Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specifi city of 56%. The PPV was 89.3% and the NPV was 42.4%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded a 94.5% sensitivity and an 88% specifi city. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modifi ed Alvarado and RIPASA scoring systems, respectively. The negative appendectomy rate decreased signifi cantly, from 18.4% to 10.7% for the modifi ed Alvarado, and to 2.2% for the RIPASA scoring system, which was a signifi cant difference (P<0.001) for both scoring systems.CONCLUSION: Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specifi city than the modifi ed Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations. The RIPASA scoring system is more accurate and specific than the modifi ed Alvarado scoring system for Kuwait population.

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Section: Discussionmentioning

confidence: 99%

Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis

Shuaib

Fakhra

et al. 2017

World Journal of Emergency Medicine

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“…The Appendicitis Inflammatory Response (AIR) score6 has been found to outperform the Alvarado score in retrospective studies in the adult population 7…”

Section: Introductionmentioning

confidence: 99%

Comparison of the use of Alvarado and AIR scores as an adjunct to the clinical diagnosis of acute appendicitis in the pediatric population

Musbahi

Rudd

Dordea

et al. 2019

World Jnl Ped Surgery

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BackgroundAcute appendicitis is one of the most common causes of acute abdominal pain with an incidence of 1.17 per 1000 and lifetime risk of approximately 7%. It remains the most common indication for emergency abdominal surgery in childhood. Diagnosis of acute appendicitis is particularly difficult in young women and the pediatric population. In the USA, CT imaging is used to avert diagnostic dilemma, however the procedure is associated with radiation risk in this vulnerable population. Additionally, the procedure has high cost and variable availability.MethodsA retrospective study involving all suspected pediatric cases of appendicitis between the ages of 5 and 17 who were operated on between 2012 and 2015 was carried out. Data were collated from clinical notes on age, sex, ultrasound findings; postoperative complications, white cell count, neutrophils, C-reactive protein, histology result, and number of days to theater. All patients in the time period were retrospectively scored on the Alvarado and Appendicitis Inflammatory Response (AIR) scores.ResultsA total of 239 patients between 11 and 17 (mean 13.6±SE) years of age were included in the study. Of these, 79 had preoperative ultrasound, of which 52 were negative, and only one patient had CT scan. 213 of the patients had an appendicectomy and 26 had diagnostic laparoscopy with no appendicectomy. Of the 213 appendixes removed, 71 were histopathologically normal, giving a negative appendectomy rate of 33.3%. 28 appendixes were perforated. The average number of days from admission to theater was 1.0 SE in males and 1.424 in females (p=0.0498). The average number of days from admission to theater in those who had ultrasound was 2.03 days compared with 0.75 in those who did not have ultrasound (p<0.0001). AIR scoring that was high and medium risk showed slightly lower negative appendicectomy rates but not significantly different.ConclusionsOur study has found no significant difference between the AIR scores and Alvarado. There is a role for scoring systems to be used to aid in the decision to undergo imaging and as an adjunct to clinical diagnosis.

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“…A new scoring system, the RIPASA scoring system, which has more sensitivity and specificity than the Alvarado scoring system, was recently established. On the other hand, the AIR scoring system consists of clinical criteria and two simple laboratory tests, the C-reactive protein (CRP) and the complete blood count tests, and can lead to a better and faster diagnosis of AA [ 9 10 11 12 13 ]. Presently, the histopathology study is the gold standard for AA diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Which One is Better? Comparison of the Acute Inflammatory Response, Raja Isteri Pengiran Anak Saleha Appendicitis and Alvarado Scoring Systems

et al. 2017

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PurposeAcute appendicitis (AA) is one of the most common causes of an acute abdomen. The accuracies of the Alvarado and the acute inflammatory response (AIR) scores in the diagnosis of appendicitis is very low in Asian populations, so a new scoring system, the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) system, was designed recently. We applied and compared the Alvarado, AIR, and RIPASA scores in the diagnoses of appendicitis in the Iranian population.MethodsWe prospectively compared the RIPASA, Alvarado, and AIR systems by applying them to 100 patients. All the scores were calculated for patients who presented with right quadrant pain. Appendectomies were performed; then, the postoperative pathology reports were correlated with the scores. Scores of 8, 7, and 5 or more are optimal cutoffs for the RIPASA, Alvarado, and AIR scoring systems, respectively. The sensitivities, specificities, positive predictive values, negative predictive values (NPVs), positive and negative likelihood ratios (LRs) for the 3 systems were determined.ResultsThe sensitivity and the specificity of the RIPASA score were 93.18% and 91.67%, respectively. The sensitivities of the Alvarado and the AIR scores were both 78.41%. The specificities of the Alvarado and the AIR scores were 100% and 91.67%, respectively. The RIPASA score correctly classified 93% of all patients confirmed with histological AA compared with 78.41% for the Alvarado and the AIR scores.ConclusionThe RIPASA scoring system had more sensitivity, better NPV, a positive LR, and a less negative LR for the Iranian population whereas the Alvarado scoring system was more specific.

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Air Score Assessment for Acute Appendicitis

Cited by 26 publications

References 9 publications

Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis

Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis

Comparison of the use of Alvarado and AIR scores as an adjunct to the clinical diagnosis of acute appendicitis in the pediatric population

Which One is Better? Comparison of the Acute Inflammatory Response, Raja Isteri Pengiran Anak Saleha Appendicitis and Alvarado Scoring Systems

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