Abstract
Introduction: In pre-imaging era, diagnosis of appendicitis was based on clinical assessment. To decrease chances of error and negative appendectomy, Alvarado was first to propose a score in 1885. A number of scores were then put forward including modification of Alvarado score. This study aimed to compare two most commonly used systems, MAS and AIRS. Methods: On admission MAS and AIRS were compared in patients of right iliac fossa pain who subsequently underwent appendectomy. Histopathologic examination was taken as gold standard outcome and MAS and AIRS as tests under evaluation. Results: Study analysed 229 patients with a mean age of 32.69 years and male to female ratio of 1.04. Female patients were older than male patients [35.25 and 30.14 years, respectively; p=0.017]. Negative appendectomy rate was just under 4%. Sensitivity, specificity, PPV and NPV of MAS were 85%, 44.4%, 97.4% and 10.8% and for AIRS were 81.8%, 11.1%, 95.7% and 2.4%. Sensitivity in children and adolescents was 90% and 72.5% for MAS and AIRS, respectively. There was no gender difference between the two. AUC for ROC curve of MAS and AIRS was 0.669 [0.474-0.863] and 0.481 [0.285-0.677] with a significant difference [p=0.0003]. Conclusion: Both scores are sensitive, underdiagnose patients as low risk, but don’t leave any patient with advanced appendicitis. MAS outperforms AIRS for all cases of appendicitis as well as advanced appendicitis. Since both scores classify a large number of patients as low risk, before deciding a surgical intervention, an imaging aid should always be welcome.
Highlights
In pre-imaging era, diagnosis of appendicitis was based on clinical assessment
When the MAS and AIRS were compared independently among the various age groups, we found the scores to be more predictable in middle age group patients compared to those in immediate younger and older age groups
267 patients underwent appendectomy constituting 8.13% of the total population of patients presenting with some symptoms suspicious of appendicitis
Summary
In pre-imaging era, diagnosis of appendicitis was based on clinical assessment. To decrease chances of error and negative appendectomy, Alvarado was first to propose a score in 1885. Conclusion: Both scores are sensitive, underdiagnose patients as low risk, but don’t leave any patient with advanced appendicitis. MAS outperforms AIRS for all cases of appendicitis as well as advanced appendicitis Since both scores classify a large number of patients as low risk, before deciding a surgical intervention, an imaging aid should always be welcome. It is not uncommon to have a decision making dilemma, whether or not to explore a patient even after imaging work up, when the literature still documents a negative appendectomy rate somewhere between 15-34% [iii,iv]. Most common scores in use are original Alvarado score [OAS] and its modification [MAS] and Appendicitis Inflammatory
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