DOI: http://dx.doi.org/10.18203/2349-2902.isj20193328

Efficacy and comparison of appendicitis inflammatory response score with Alvarado score in predicting the diagnosis of acute appendicitis

Abhishek Kumar, K. G. Byakodi, Prathamesh P. Chandrapattan, Vasant Teggimani

Abstract


Background: Aute appendicitis being the most common surgical emergency poses a significant diagnosing dilemma. Early diagnosis has very favourable outcomes and if diagnosis is delayed leads to significant morbidity and mortality. USG has some limitations and best investigation computed tomography (CT) is being overused which leads to unnecessary exposure to radiation especially in children and young adult. Scoring systems are a valuable aid when it comes to diagnosing appendicitis.

Methods: Study done in department of surgery in KIMS, Hubli. The study period was December 2015– September 2016, and 107 patients with right lower abdomen pain were studied. History, clinical examination, biochemical, haematological, radiological investigations were done. Alvarado and AIR scores were calculated. Considering HPR report as gold standard the scores were compared.

Results: There were 70 male patients (66%) and 37 female patients (34%). The mean age in our study population was 28.1 years ±13.57 years. The overall area under the receiver operating characteristic (ROC) curve of the AIR score was 0.967 and significantly better than the area under the curve of 0.825 of the Alvarado score (p=0.05).

Conclusions: This study externally validates the AIR score for patients with acute appendicitis. The scoring system has a high discriminating power compared to Alvarado score especially in cases in which appendicitis is difficult to diagnose such as females, children, elderly, in advanced cases and very effective supplement to available radiological investigations.


Keywords


Acute appendicitis, Alvarado score, AIR score, Histopathology, Receiver operating characteristic

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References


Zinner MJ, Ashley SW. Maingot’s abdominal operations. 12th Edition. İstanbul: Nobel Tıp Kitabevleri Ltd Şti; 2008: 939–968.

Cuschieri J, Florence M, Flum DR, Jurkovich GJ, Lin P, Steele SR, et al. Negative appendectomy and imaging accuracy in the Washington state surgical care and outcomes assessment program. Ann Surg 2008;248:557–63.

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15:557-64.

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.

Sammalkorpi HE, Mentula P, Leppäniemi A. A new adult appendicitis score improves diagnostic accuracy of acute appendicitis: a prospective study. BMC Gastroenterol. 2014;14:114.

McBurney C. Experience with early operative interference in cases of disease of the vermiform appendix. New York Medical J. 1889;50:676-84.

Marudanayagam R, Williams GT, Rees BI. Review of the pathological results of 2660 appendicectomy specimens. J Gastroenterol. 2006;41:745–9.

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;32:1843-49.

Kollár D, McCartan DP, Bourke M, Cross KS, Dowdall J. Predicting Acute Appendicitis? A comparison of the Alvarado Score, the Appendicitis Inflammatory Response Score and Clinical Assessment. World J Surg. 2015;39(1):104-9.

Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004;91:28-37.