Comparison of acute inflammatory score and Alvarado score in diagnosis of acute appendicitis at a tertiary care hospital

Abstract

Background: Acute appendicitis remains as one of the most common surgical entity requiring early intervention. Hence there is always a need to develop a well-designed protocol for diagnosis and to reduce negative appendectomy. The most common and widely applied was Alvarado score and best performed in validating studies, but was observed with few drawbacks. A recently introduced appendicitis inflammatory response score (AIR) was designed to overcome the drawbacks associated with the implementation of Alvarado scoring system. The objective the present study was to evaluate the AIR score on cases of suspicious appendicitis and to compare it with Alvarado scorings system.Methods: A prospective study for a period of two years from March 2015 to February 2017 was conducted on consecutive patients who presented to emergency department and scoring was performed based on the necessary variables.Results: The present study was conducted on 300 cases suspicious of appendicitis. The results analysed showed the area under the ROC curve of the AIR score was 0.94 and better than the area under the curve of Alvarado score of 0.82. The AIR score also did well in difficult cases of women, children when compared to Alvarado score in diagnosis of appendicitis. In our study, in cases with >8 points, a lower sensitivity was observed in AIR scoring than Alvarado scoring (0.26 vs. 0.12), but was associated with higher specificity (1.00 vs. 0.95). In these cases, PPV turned out to be 1.00 for AIR scoring and 0.77 for Alvarado scoring.Conclusions: To conclude, AIR scoring performed well almost equally with Alvarado system with high specificity and high negative predictive value preventing unnecessary negative appendectomies. Follow up of these cases will help in deciding surgical intervention in unnecessary cases. This scoring system also prevents unnecessary and costly radiological investigations thereby reducing the financial burden to the patients.

Comparison between AIR score and Alvarado score in cases of non-perforated and perforated acute appendicitis

“…But in Alvarado scoring, 17 cases were in high risk and 20 cases in low risk group. 23 It was observed in the present study that for scores >4, AIR score has higher sensitivity and specificity (98.33% and 91.20%) as compared to Alvarado score (81.33% and 12.33%). The negative predictive value (NPV) of AIR score and Alvarado score was 81.66% and 78.26% respectively while the positive predictive value (PPV) of AIR score and Alvarado score was 89.22% and 54.92% respectively.…”

“…In these cases, PPV turned out to be 1.00 for AIR scoring and 0.77 for Alvarado scoring. 23 Patil S et al, study reported sensitivity of AIR of 89.9% (at score >4), Both AIR and Alvarado (at score >8) demonstrated specificity of 12.3% and 21.3% respectively and specificity of Alvarado (at score >4) at 54.5%. 22 Sudhir S et al, study reported cases of phlegmonous appendicitis, for scores >4, Alvarado score has high sensitivity (97.06) compared to AIR score (78.43).…”

“…Nonspecific abdominal pain was found in 72 cases. 23 Sudhir S et al, study reported overall 109 patients out of 200 had pathologically proven appendicitis. Fifty-three (26.5%) patients had phlegmonous appendicitis, 49 (24.5%) had advanced appendicitis.…”

Evaluation of the Appendicitis Inflammatory Response Score against Alvarado Score in Diagnosis of Acute Appendicitis

“…Particularly among the children, elderly and females of reproductive age, where other conditions can present with signs and symptoms similar to those of acute appendicitis, diagnosis is difficult to establish. 1,2 Management of patients with equivocal diagnosis is also controversial. 2,3 Delay in treatment increases the incidence of complications.…”

“…1,2 Management of patients with equivocal diagnosis is also controversial. 2,3 Delay in treatment increases the incidence of complications. 4,5 Diagnosis of acute appendicitis is eminently clinical, being supplemented with laboratory findings and imaging modalities.…”