DOI: http://dx.doi.org/10.18203/2349-2902.isj20191028

Comparison between AIR score and Alvarado score in cases of non-perforated and perforated acute appendicitis

Debabrata Gope, Anuradha Santosh Dnayanmote, Saurav Mahesh Thakkar, Akriti Rajkumar Tulsian, Shweta Achuthan Kutty, Miten Ranka, Kuldip Annasaheb Patil, K. Srilikhitha

Abstract


Background: Acute abdominal pain is a common complaint in the emergency department. Diagnostics of one of the most common pathologies behind acute abdominal pain, acute appendicitis, has radically changed over the last decades. There are several different diagnostic scores for suspected acute appendicitis. The Alvarado score being most widely known. Appendicitis Inflammatory Response (AIR) score was designed to overcome drawbacks of previous scores. This score incorporated the C-reactive protein value in its design and was developed and validated on a prospective cohort of patients with suspicion of acute appendicitis.

Methods: Patients with pain in RIF were admitted. Scores were assessed, patients whose score was significant by either of the system were subjected for appendicectomy. The specimens of appendix were sent for histo-pathological examination (HPE). Post-operative histopathology report was correlated with the scores. Sensitivity, specificity, positive predictive value and negative predictive for AIR and Alvarado score were calculated.

Results: For scores >4, AIR score has higher sensitivity and specificity. The negative predictive value (NPV) of AIR score was higher and the positive predictive value (PPV) of AIR score was also high. For scores >8, Alvarado score has higher sensitivity as compared to AIR score whereas AIR score has higher specificity as compared to Alvarado score. NPV of Alvarado score was higher while PPV of AIR score was higher.

Conclusions: In this study AIR score had Alvarado score displaying higher sensitivity and specificity.


Keywords


Appendicitis inflammatory response, C-reactive protein, Computed tomography, Erythrocyte sedimentation rate, Magnetic resonance imaging, Right lower quadrant, Receiver operating characteristics

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References


Gilmore OJ, Browett JP, Griffin PH, Ross IK, Brodribb AJ, Cooke TJ, et al. Appendicitis and mimicking conditions. A prospective study. Lancet. 1975;2(7932):421-4.

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(1):37-41.

Hoffmann J, Rasmussen OO. Aids in the diagnosis of acute appendicitis. Br J Surg. 1989;76(8):774-9.

Lewis FR, Holcroft JW, Boey J, Dunphy JE. Appendicitis. A critical review of diagnosis and treatment in 1000 cases. Arch Surg. 1975;110(5):677-684.

Körner H, Söndenaa K, Söreide JA, Andersen E, Nysted A, Lende TH, et al. Incidence of acute non-perforated and perforated appendicitis: age-specific and sex-specific analysis. World J Surg. 1997;21(3):313.

Livingston EH, Woodward WA, Sarosi GA, Haley RW. Disconnect between incidence of non-perforated and perforated appendicitis: implications for pathophysiology and management. Ann Surg. 2007 Jun;245(6):886.

Boonstra PA, van Veen RN, Stockmann HB. Less negative appendectomies due to imaging in patients with suspected appendicitis. Surg Endosc. 2015;29(8):2365-70.

Raja AS, Wright C, Sodickson AD, Zane RD, Schiff GD, Hanson R, et al. Negative appendectomy rate in the era of CT: an 18-year perspective. Radiol. 2010;256(2):460-5.

Poletti PA, Platon A, De Perrot T, Sarasin F, Andereggen E, Rutschmann O, et al. Acute appendicitis: prospective evaluation of a diagnostic algorithm integrating ultrasound and low-dose CT to reduce the need of standard CT. Eur Radiol. 2011;21(12):2558-66.

Atema JJ, Gans SL, Van Randen A, Laméris W, van Es HW, van Heesewijk JP, et al. Comparison of imaging strategies with conditional versus immediate contrast-enhanced computed tomography in patients with clinical suspicion of acute appendicitis. Eur Radiol. 2015;25(8):2445-52.

van Randen A, Bipat S, Zwinderman AH, Ubbink DT, Stoker J, Boermeester MA. Acute appendicitis: meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease. Radiology. 2008;249(1):97-106.

Apisarnthanarak P, Suvannarerg V, Pattaranutaporn P, Charoensak A, Raman SS, Apisarnthanarak A. Alvarado score: can it reduce unnecessary CT scans for evaluation of acute appendicitis? Am J Emerg Med. 2015;33(2):266-70.

Di Saverio S, Birindelli A, Kelly MD, Catena F, Weber DG, Sartelli M, et al. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg. 2016;11:34.

Gorter RR, Eker HH, Gorter-Stam MA, Abis GS, Acharya A, Ankersmit M, et al. Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surg Endosc. 2016;30(11):4668-90.

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15(5):557-64.

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(8):1843-9.

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.

De Castro SM, Ünlü C, Steller EP, Van Wagensveld BA, Vrouenraets BC. Evaluation of the appendicitis inflammatory response score for patients with acute appendicitis. World J Surg. 2012 Jul 1;36(7):1540-5.

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

Ohmann C, Franke C, Yang Q. Diagnostic score for acute appendicitis. Chirurg. 1995:66:135-41.

Enochsson L, Gudbjartsson T, Hellberg A. The Fenyo-Lindberg scoring system for appendicitis increases positive predictive value in fertile women a prospective study in 455 patients randomized to either laparoscopic or open appendectomy. Surg Endosc. 2004;18:1509-13.

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.

Gopalam PR, Konidala MVSS. Comparison of acute inflammatory score and Alvarado score in diagnosis of acute appendicitis at a tertiary care hospital. Int Surg J. 2017;4:4034-8.

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. 2017;3(1):21-6.