Validity of Appendicitis Inflammatory Response Score in Distinguishing Perforated from Non-Perforated Appendicitis in Children

Abstract

Background: This prospective observational study aimed to evaluate the validity of appendicitis inflammatory response (AIR) score in differentiating advanced (perforated) from simple (non-perforated) appendicitis in pediatric patients. Methods: A single-center prospective cross-sectional study was conducted between 1 January 2019 until 1 May 2020 including 184 pediatric patients who underwent appendectomy. Based on the intraoperative finding of advanced (n = 38) or simple (n = 146) appendicitis the patients were divided into two groups. Recipient-operator curve (ROC), with calculation of sensitivity and specificity of best cutoff and the area under the curve (AUC), were used to measure the diagnostic value and the potential for risk stratification of the AIR score, among the patients with simple or advanced acute appendicitis. Results: The median value of the AIR score in the perforated and non-perforated groups was 10 (interquartile range, IQR 9, 11), and was 7 (IQR 6, 9), respectively (p < 0.001). Based on the calculated value of AIR score, the patients were classified with a high precision into low, indeterminate and high risk groups for acute appendicitis (p < 0.001). A cutoff value of ≥9 was demonstrated to serve as a reliable indicator of perforated appendicitis with a sensitivity and a specificity of 89.5% and 71.9%, respectively (AUC = 0.80; 95% CI: 0.719–0.871; p < 0.001). Conclusions: Acute appendicitis can be detected with a high level of sensitivity and specificity using the AIR score. Also, the AIR score may differentiate perforated from non-perforated appendicitis in pediatric patients with a high level of accuracy.

Incidence of Complicated Appendicitis during the COVID-19 Pandemic versus the Pre-Pandemic Period: A Systematic Review and Meta-Analysis of 2782 Pediatric Appendectomies

“…Acute appendicitis is the most common condition in the pediatric population that leads to emergency abdominal surgery [1,2]. Although advanced diagnostic imaging is widely available, the initial diagnosis of appendicitis in children can be challenging, with rates of misdiagnosis reaching 100% in children aged two years or younger [3][4][5][6]. This has been attributed to nonspecific presentation and overlap of symptoms with other common Diagnostics 2022, 12, 127 2 of 13 childhood conditions such as mesenteric lymphadenitis, gastroenteritis, or Meckel's diverticulitis.…”

“…This has been attributed to nonspecific presentation and overlap of symptoms with other common Diagnostics 2022, 12, 127 2 of 13 childhood conditions such as mesenteric lymphadenitis, gastroenteritis, or Meckel's diverticulitis. Clinical scores, such as Alvarado, appendicitis inflammatory response score, and pediatric appendicitis score have been developed to aid the diagnosis of acute appendicitis in children [3,4]. The diagnostic delay often leads to a higher incidence of complications, such as perforation.…”

Presurgical time and associated factors as predictors of acute perforated appendicitis: a prospective cohort study in a teaching pediatric hospital in Colombia

“…The Alvarado score is a frequently utilized tool for acute appendicitis symptom gradation, yet it lacks specificity and sensitivity [ 19 ]. Recently, Appendicitis inflammatory score (AIR) has been created to overcome shortcomings of the Alvarado score and Pediatric appendicitis score [ 20 ]. Recent studies validated the AIR score and reported that the AIR score significantly outperforms the older Alvarado score, especially in distinguishing simple from advanced appendicitis but still not enough to be exclusive criteria in establishing the diagnosis of acute appendicitis [ 21 ].…”

Predictive Factors to Diagnose Appendicitis in Children in the Emergency Department

“… 10 One prospective observational study presented the validity of the AIR score in distinguishing pediatric appendicitis patients with simple and perforated appendicitis with 89.5% sensitivity and 71.9% specificity by using a cut-off value of 9. 11 In contrast to the Alvarado and PAS scores, the AIR score uses CRP as one of the variables in detecting inflammatory response or process. 11 Moreover, recent studies explored the ability of hyponatremia and hyperbilirubinemia as discriminative markers of complicated appendicitis.…”

“… 11 In contrast to the Alvarado and PAS scores, the AIR score uses CRP as one of the variables in detecting inflammatory response or process. 11 Moreover, recent studies explored the ability of hyponatremia and hyperbilirubinemia as discriminative markers of complicated appendicitis. However, hyponatremia was studied only in the pediatric population, whereas hyperbilirubinemia was studied in both pediatric and adult patients.…”