Comparison of acute inflammatory score and Alvarado score in diagnosis of acute appendicitis at a tertiary care hospital
DOI:
https://doi.org/10.18203/2349-2902.isj20175405Keywords:
Acute appendicitis, Alvarado scoring system, Appendicitis inflammatory score, SpecificityAbstract
Background: Acute appendicitis remains as one of the most common surgical entity requiring early intervention. Hence there is always a need to develop a well-designed protocol for diagnosis and to reduce negative appendectomy. The most common and widely applied was Alvarado score and best performed in validating studies, but was observed with few drawbacks. A recently introduced appendicitis inflammatory response score (AIR) was designed to overcome the drawbacks associated with the implementation of Alvarado scoring system. The objective the present study was to evaluate the AIR score on cases of suspicious appendicitis and to compare it with Alvarado scorings system.
Methods: A prospective study for a period of two years from March 2015 to February 2017 was conducted on consecutive patients who presented to emergency department and scoring was performed based on the necessary variables.
Results: The present study was conducted on 300 cases suspicious of appendicitis. The results analysed showed the area under the ROC curve of the AIR score was 0.94 and better than the area under the curve of Alvarado score of 0.82. The AIR score also did well in difficult cases of women, children when compared to Alvarado score in diagnosis of appendicitis. In our study, in cases with >8 points, a lower sensitivity was observed in AIR scoring than Alvarado scoring (0.26 vs. 0.12), but was associated with higher specificity (1.00 vs. 0.95). In these cases, PPV turned out to be 1.00 for AIR scoring and 0.77 for Alvarado scoring.
Conclusions: To conclude, AIR scoring performed well almost equally with Alvarado system with high specificity and high negative predictive value preventing unnecessary negative appendectomies. Follow up of these cases will help in deciding surgical intervention in unnecessary cases. This scoring system also prevents unnecessary and costly radiological investigations thereby reducing the financial burden to the patients.
Metrics
References
Seal A. Appendicitis: a historical review. Can J Surg. 1981;24:427-33.
Borges PSG, Nogueira LMC, Neto GHF. Validation of the Alvarado score in the diagnosis of acute appendicitis in children and adolescents at the Instituto Materno Infantil de Pernambuco-IMIP. Infant. 2003;3(4):439-45.
Andersson RE, Hugander A, Thulin AJ. Diagnostic accuracy and perforation rate in appendicitis: Association with age and sex of the patient and with appendicectomy rate. Eur J Surg. 1992;158:37-41.
Florence M, Flum DR, Jurkovich GJ, Lin P, Steele SR, Symons RG, et al. Negative appendectomy and imaging accuracy in the Washington state surgical care and outcomes assessment program. Annals of surgery. 2008;248(4):557-63.
Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15:557-64.
Patil S, Harwal R, Harwal S, Kamthane S. Appendicitis inflammatory response score: a novel scoring system for acute appendicitis. Int Surg J. 2017;4:1065-70.
Flum DR, Koepsell T. The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg. 2002;137(7):799-804.
Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004;91:28-37.
Andersson M, Andersson RE. The appendicitis inflammatory response score: A tool for the diagnosis of acute appendicitis that outperforms the Alvarado score. World J Surg. 2008;32:1843-9.
Sudhir S, Sekhar AP. Evaluation of Appendicitis Inflammatory Response Score as a Novel Diagnostic Tool for Diagnosis of Acute Appendicitis and its Comparison with Alvarado Score. IJSS Journal of Surgery. 2017;3(1):21-6.
Kim BS, Ryu DH, Kim TH, Jeong U, Song JH, Cho SI, et al. Diagnosis of acute appendicitis using scoring system: compared with the Alvarado score. J Korean Surg Soc. 2010;79:207-14.
Ohmann C, Franke C, Yang Q, Margulies M, Chan M, Van Elk PJ, et al. Diagnostic score for acute appendicitis. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen. 1995;66(2):135-41.
De Castro SMM, Ünlü C, Steller EPH, Wagensveld BA, Vrouenraets BC. Evaluation of the appendicitis inflammatory response score for patients with acute appendicitis. World J Surg. 2012;36(7):1540-5.
Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004;91:28-37.
Downloads
Published
How to Cite
Issue
Section
