Efficacy and comparison of appendicitis inflammatory response score with Alvarado score in predicting the diagnosis of acute appendicitis

Abstract

Background: Aute appendicitis being the most common surgical emergency poses a significant diagnosing dilemma. Early diagnosis has very favourable outcomes and if diagnosis is delayed leads to significant morbidity and mortality. USG has some limitations and best investigation computed tomography (CT) is being overused which leads to unnecessary exposure to radiation especially in children and young adult. Scoring systems are a valuable aid when it comes to diagnosing appendicitis.Methods: Study done in department of surgery in KIMS, Hubli. The study period was December 2015– September 2016, and 107 patients with right lower abdomen pain were studied. History, clinical examination, biochemical, haematological, radiological investigations were done. Alvarado and AIR scores were calculated. Considering HPR report as gold standard the scores were compared.Results: There were 70 male patients (66%) and 37 female patients (34%). The mean age in our study population was 28.1 years ±13.57 years. The overall area under the receiver operating characteristic (ROC) curve of the AIR score was 0.967 and significantly better than the area under the curve of 0.825 of the Alvarado score (p=0.05).Conclusions: This study externally validates the AIR score for patients with acute appendicitis. The scoring system has a high discriminating power compared to Alvarado score especially in cases in which appendicitis is difficult to diagnose such as females, children, elderly, in advanced cases and very effective supplement to available radiological investigations.

The Efficacy of Appendicitis Inflammatory Response Score in Diagnosis of Acute Appendicitis

“…1 A clinical diagnosis alone leads to a negative appendectomy rate of 15 to 30%. 2 The diagnosis is especially difficult for women of reproductive age and with gynecological disease. The use of ultrasound and CT scans, in addition to clinical assessment and blood tests, has reduced the rate of negative appendicectomy to less than 10%.…”

“…1 The Appendicitis Inflammatory Response (AIR) Score is a developed diagnostic tool that uses seven variables (vomiting, right iliac fossa pain, rebound tenderness, temperature, WBC count, neutrophil count and CRP) to stratify patients into low, intermediate, and high-risk groups. 2 That has been validated and found to perform the Alvarado Score. [7][8][9] The AIR score demonstrated higher sensitivity and specificity compared to the Alvarado score.…”

“…AIR score . 2 The aim of this study is to see the potential benefits of risk stratification by the AIR score to guide clinical decision-making. According to the AIR score, 44 of the low-risk patients had RIF pain, 22 had light rebound tenderness, TLC in 10 mm3 in 44 (100%) patients, and neutrophils were in the range of 70-84% in 22 (50%) patients.…”