Evaluation of Alvarado score and appendicitis inflammatory response score as diagnostic tools for acute appendicitis
Keywords:Appendicitis, Alvarado, AIR
Background: The study aims to evaluate the diagnostic accuracy of AIR and Alvarado scores for acute appendicitis cases.
Methods: We conducted a retrospective study with 73 patients to compare the efficacy of the appendicitis inflammatory response (AIR) score with the Alvarado score in the diagnosis of acute appendicitis from January 2021 to March 2021. The study included all consecutive patients referred with suspected appendicitis or acute RIF pain, to the surgical unit at Tunbridge Wells Hospital.
Results: Based on histopathology findings of 73 patients, 59 (80.8%) patients had acute appendicitis. Using the AIR score, 5 (8.5%) patients scored high, 41 (69.5%) scored moderate, and 13 (22.0%) scored low in the histologically-positive group. In the histology-negative group, none (0.0%) scored high, 2 (14.3%) scored moderate, and 12 (85.7%) scored low, with only 2 patients being false positives. The correlation between the AIR score and histopathology results was thus highly significant (p value=0.000). Using the Alvarado score, in the histology-positive group, 33 (55.9%) scored high, 17 (28.8%) moderate and 9 (15.3%) low. In the histology-negative group, 2 (14.3%) patients scored high, 6 (42.9%) scored moderate, and 6 (42.9%) patients scored low. 8 patients were false positives. We found a significant correlation between the Alvarado score and histopathology results (p value=0.011). The sensitivity of the AIR and Alvarado scores were 77.97% and 67.80% respectively and the specificity was 85.71% and 78.57% respectively.
Conclusions: The AIR score had higher specificity, sensitivity, positive predictive value, and a lower rate of false positives.
Henderson J, Goldacre MJ, Fairweather JM, Marcovitch H. Conditions accounting for substantial time spent in hospital in children aged 1-14 years. Arch Dis Child. 1992;67:83-86.
Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132:910-25.
Lee JH, Park YS, Choi JS. The epidemiology of appendicitis and appendectomy in South Korea: national registry data. J Epidemiol. 2010;20:97-105.
Kabir SA, Kabir SI, Sun R, Jafferbhoy S, Karim A. How to diagnose an acutely inflamed appendix; a systematic review of the latest evidence. Int J Surg Lond Engl. 2017;40:155-62.
Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Does this child have appendicitis? JAMA. 2007;298:438-51.
Irish MS, Pearl RH, Caty MG, Glick PL. The approach to common abdominal diagnosis in infants and children. Pediatr Clin North Am. 1998;45:729-72.
Marzuillo P, Germani C, Krauss BS, Barbi E. Appendicitis in children less than five years old: a challenge for the general practitioner. World J Clin Pediatr. 2015;4:19-24.
Paulson EK, Kalady MF, Pappas TN.: Clinical practice. Suspected appendicitis. N Engl J Med. 2003; 348:236-42.
Flum DR, Koepsell T. The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg Chic Ill. 2002;137:799-804.
Flum DR, Morris A, Koepsell T, Dellinger EP. Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA. 2001;286:1748-53.
Sharma R, Kasliwal DK, Sharma RG.: Evaluation of negative appendicectomy rate in cases of suspected acute appendicitis and to study the usefulness of ultrasonography in improving the diagnostic accuracy. Indian J Surg. 2007;69:194-7.
Chan J, Fan KS, Mak TLA, Loh SY, Ng SWY, Adapala R.: Pre-operative imaging can reduce negative appendectomy rate in acute appendicitis. Ulster Med J. 2020;89:25-8.
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.
Alvarado A.: A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15:557-64.
Samuel M.: Pediatric appendicitis score. J Pediatr Surg. 2002;37:877-81.
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.
Lintula H, Kokki H, Pulkkinen J, Kettunen R, Gröhn O, Eskelinen M. Diagnostic score in acute appendicitis. Validation of a diagnostic score (Lintula score) for adults with suspected appendicitis. Langenbecks Arch Surg. 2010;395:495-500.
Chong CF, Adi MIW, Thien A. Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis. Singapore Med J. 2010;51:220-5.
Kharbanda AB, Vazquez-Benitez G, Ballard DW, et al.: Development and validation of a novel pediatric appendicitis risk calculator (pARC). Pediatrics. 2018; 141:e20172699.
Livingston EH, Woodward WA, Sarosi GA, Haley RW. Disconnect between incidence of nonperforated and perforated appendicitis: implications for pathophysiology and management. Ann Surg. 2007; 245:886-92.
Raja AS, Wright C, Sodickson AD. Negative appendectomy rate in the era of CT: an 18-year perspective. Radiology. 2010, 256:460-5.
National Surgical Research Collaborative. Multicentre observational study of performance variation in provision and outcome of emergency appendicectomy. Br J Surg. 2013;100:1240-52.
McKay R, Shepherd J. The use of the clinical scoring system by Alvarado in the decision to perform computed tomography for acute appendicitis in the ED. Am J Emerg Med. 2007;25:489-93.
Coleman JJ, Carr BW, Rogers T. The Alvarado score should be used to reduce emergency department length of stay and radiation exposure in select patients with abdominal pain. J Trauma Acute Care Surg. 2018;84:946-50.
Andersson REB.: Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004, 91:28-37.
Jose T, Rajesh PS. Appendicitis inflammatory response score in comparison to Alvarado score in acute appendicitis. Surg JNYN. 2021;7:e127-31.
de Castro SMM, 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;36:1540-45.
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;39:104-9.
Macco S, Vrouenraets BC, de Castro SMM. Evaluation of scoring systems in predicting acute appendicitis in children. Surgery. 2016;160:1599-604.
Vaziri M, Nafissi N, Jahangiri F, Nasiri M. Comparison of the appendicitis inflammatory response and Alvarado scoring systems in the diagnosis of acute appendicitis in children. J Med Life. 2021;14:75-80.