Evaluation of the Appendicitis Inflammatory Response Score for Patients with Acute Appendicitis

Abstract

BackgroundAcute appendicitis is still a difficult diagnosis. Scoring systems are designed to aid in the clinical assessment of patients with acute appendicitis. The Alvarado score is the most well known and best performing in validation studies. The purpose of the present study was to externally validate a recently developed appendicitis inflammatory response (AIR) score and compare it to the Alvarado score.MethodsThe present study selected consecutive patients who presented with suspicion of acute appendicitis between 2006 and 2009. Variables necessary to evaluate the scoring systems were registered. The diagnostic performance of the two scores was compared.ResultsThe present study included 941 consecutive patients with suspicion of acute appendicitis. There were 410 male patients (44%) and 531 female patients (56%). The area under the receiver operating characteristic curve of the AIR score was 0.96 and significantly better than the area under the curve of 0.82 of the Alvarado score (p < 0.05). The AIR score also outperformed the Alvarado score when analyzing the more difficult patients, including women, children, and the elderly.ConclusionsThis study externally validates the AIR Score for patients with acute appendicitis. The scoring system has a high discriminating power and outperforms the Alvarado score.

The Systemic Inflammatory Response in Patients with Appendicitis: a Progressive Phenomenon

“…d Progression of Creactive protein levels was steady and consequent with progression of the diagnostic interval, being more marked after 48 h. e SIRS points increased with progression of the diagnostic interval; after 73 h, most patients had three or four points, and this was consequent with the instauration of the septic process WBC Leukocytosis is the most frequent and expected parameter to be present in patients with appendicitis and is considered the best laboratory method to support the diagnosis of uncomplicated appendicitis [4,6,20]. Although the absence of leukocytosis does not rule out appendicitis [3,21], its presence supports the clinical diagnosis [2][3][4][5][6][7][8]20]. It is expected that patients with advanced disease have higher WBC count due to increased polymorphonuclear cell count [5,12,20].…”

“…CRP is an unspecific inflammatory marker useful to support the clinical diagnosis of appendicitis together with WBC and clinical parameters [3,5,6,8]. Higher values of CRP strongly correlate with appendicitis [3,4,6,20].…”

“…The inflammatory response to acute life-threatening conditions including appendicitis has been a subject of intensive study [1][2][3][4][5][6][7][8]. The regional and systemic responses have been described [2,4], inflammatory parameters have been applied to diagnostic algorithms [3][4][5][6], and diagnostic scores incorporating inflammatory parameters have been developed [7,8].…”

“…The regional and systemic responses have been described [2,4], inflammatory parameters have been applied to diagnostic algorithms [3][4][5][6], and diagnostic scores incorporating inflammatory parameters have been developed [7,8]. The systemic inflammatory response syndrome (SIRS) reflects the human inflammatory response to injury and infection [9].…”

The Alvarado score versus computed tomography in the diagnosis of acute appendicitis: A prospective study

“…3,4 More recent scores such as the RIPASA (a 15-parameter score initially validated in southeast Asia) and the Appendicitis Inflammatory Response (AIR) (7-parameter score including CRP measurement) scores, although more elaborate and showing better performance than AS, are more complex and may be inconvenient in emergency department. [5][6][7] As such, we have used the original AS, which was more widely used and evaluated, in this study.…”