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


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.


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

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