Predicting Acute Appendicitis? A comparison of the Alvarado Score, the Appendicitis Inflammatory Response Score and Clinical Assessment

Kollár, Dániel; McCartan, Damian; Bourke, Michael; Cross, K.S.; Dowdall, Joseph

doi:10.1007/s00268-014-2794-6

Cited by 100 publications

(78 citation statements)

References 23 publications

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“…The Alvarado score stratification was modified slightly based on Kollár et al ’s method8 of predicting acute appendicitis in adults to match the AIR scoring system, which provides a similar stratification to that used by Ohle et al 9. Patients were stratified into low, medium and high risks of appendicitis groups (table 1).…”

Section: Methodsmentioning

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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Section: Methodsmentioning

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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“…Among clinical scores, that combine simplicity of computation and higher likelihood ratio (LR) or likelihood ratio, the Appendicitis Inflammatory Response Score or Appendicitis Inflammatory Response Score (AIR score) has been shown to be more accurate than the Alvarado's score. 7,8 In the AIR score the scale goes from 0 to 12. High risk patients for appendicitis range 8-12: Patients who range 5-8, remain uncertain for a diagnosis of AA and the clinical experience and imaging still play a considerable role (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Acute appendicitis: not just a therapeutic puzzle to solve

et al. 2017

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Over the last 5 years, acute appendicitis (AA) is definitely drawing the scientific attention. As the timing in efficiently and promptly treating patients with AA is essential, any potential blind spot in understanding the disease should be clarified. Consequently, physicians will be able to address the patient towards the more appropriate therapeutic pathway (antibiotic or surgery) and avoid any harmful delay. Currently, neither surgery nor antibiotic seem offer a remarkable advantage to the patients therefore surgery remains the gold-standard in treating AA in accordance to the historical dogma.

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“…In 2014, Kollár et al published their results from a cross-sectional study from Ireland of 182 consecutive patients with suspected appendicitis 225 . The diagnostic properties of the AIR score, Alvarado score and the clinical impression of a senior surgeon were assessed.…”

Section: External Validation Of the Air Scorementioning

confidence: 99%

Structured management of patients with suspected acute appendicitis

Andersson¹

2015

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Predicting Acute Appendicitis? A comparison of the Alvarado Score, the Appendicitis Inflammatory Response Score and Clinical Assessment

Abstract: The AIR score is accurate at excluding appendicitis in those deemed low risk and more accurate at predicting appendicitis than the Alvarado score in those deemed high risk. Its use as the basis for selective CT imaging in those deemed medium risk should be considered.

Cited by 100 publications

References 23 publications

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

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

Acute appendicitis: not just a therapeutic puzzle to solve

Structured management of patients with suspected acute appendicitis

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