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

Abstract

Background Patients presenting with suspected appendicitis pose a diagnostic challenge. Various scoring systems have been designed to aid in the clinical assessment of these patients. Widely applied was Alvarado score and best performed in validating studies, but was observed with few drawbacks. Appendicitis inflammatory response (AIR) score was designed to overcome the drawbacks associated with the implementation of Alvarado scoring system.
 Objective The main objective of this study was to evaluate the Appendicitis inflammatory Response Score and compare its performance in predicting risk of appendicitis with the Alvarado score.
 Method Appendicitis inflammatory response score and Alvarado scores were calculated prospectively on patients suspected of acute appendicitis presenting to Manipal Teaching Hospital, Pokhara, Nepal between July 2017 and June 2019. Diagnostic performance of the two scores was compared. Statistical analysis was done using SPSS 21 and p value < 0.05 was considered significant.
 Result The study included 217 patients with 109 (50.2%) males and 108 (49.8%) females. The mean age of patients was 25.77±15.54. The results analyzed showed better sensitivity of Appendicitis Inflammatory Response score (96.91%) as compared to 94.30% of Alvarado score. The positive and negative predictive values of Alvarado score were 74.87% and 50%, as compared to 79.70% and 72.20% for AIR score. Furthermore, the area under receiver operating curve of the appendix inflammatory response score was better (0.701) than that of Alvarado score (0.580).
 Conclusion Appendicitis Inflammatory Response (AIR) scoring performed well and more accurate than Alvarado scoring system with high specificity and high negative predictive value preventing negative appendectomies.

Evaluation and comparison of the results of the Alvarado scoring system with acute inflammatory response score in the diagnosis of acute appendicitis based on the pathological evidence

“…Besides, the measured AUC in their study was considerably higher in AIRS (0.701) than Alvarado (0.580) showing the reliability of this conclusion. Although their study design was totally similar to ours the measured specificities at both cutpoints of >4 and >8 were remarkably lower than what we found for both AIRS and Alvarado (15).…”

Valoración del Score Alvarado y respuesta inflamatoria aguda para el diagnóstico de apendicitis aguda en pacientes adultos de 20 a50 años de edad en el servicio de cirugia general en el Hospital Rezola de Cañete de julio 2018 a junio del 2021

“…Por último, se concluye que la puntuación de la Respuesta Inflamatoria de la Apendicitis (AIR) funcionó bien y fue más precisa que el sistema de puntuación de Alvarado con alta especificidad y alto valor predictivo negativo que previene las apendicectomías negativas. 7 Rodas J (2020) en su investigación titulada "Evaluación de la Escala de Alvarado versus Score de Respuesta Inflamatoria de la Apendicitis, Hospital José Carrasco Arteaga 2018", detalla que la apendicitis aguda es la principal causa de abdomen agudo no traumático en el mundo y su diagnóstico aún es desafiante. Ante los cuadros atípicos es indispensable apoyarse en las escalas o scores diagnósticos, siendo los más estudiados son la Escala de Alvarado, RIPASA entre otras.…”