Appendicitis Inflammatory Response Research Articles

Different Recent Scoring Systems for Better Diagnosis of Acute Appendicitis

Abstract Background Acute appendicitis is one of the most common surgical emergencies, with a lifetime prevalence rate of approximately one in seven. Aim of the Work to compare RIPASA score, (AIR) score and Modified Alvarado Score widely and easily used scoring systems, in order to identify which one is the best in sensitivity, specificity, positive predictive value, negative predictive value and accuracy, So which one leads to the most accurate diagnosis of acute Appendicitis. Patients and Methods A randomized prospective study that was conducted in Ain-Shams University Hospitals. The study started in February 2022 till the number of cases is fulfilled. 50 patients presented with RT iliac fossa tenderness. Each patient was scored by the three scoring systems using history, examination, clinical labs. Results 66.0% of cases were positive confirmed histology and (34.0%) cases were negative confirmed histology. There were highly statistically significant difference between Negative Confirmed histology and Positive Confirmed histology regarding RIPASA score, (AIR) score and Modified Alvarado Score. In this study, receiver operating characteristic curve (ROC) shows that the best cut off point of Modified Alvarado Score to detect Positive Modified Alvarado Score group was found >5 * with sensitivity of 87.88%, specificity of 64.71%, PPV of 82.9%, NPV of 73.3% and total accuracy of 77.0%. Conclusion the Appendicitis Inflammatory Response score and Raja Isteri Pengiran Anak Saleha Appendicitis score have high discriminating powers and outperform the Modified Alvarado score. They could aid in selecting patients who require timely surgery or those who require further evaluation. Both these scores have the potential to turn out into scoring systems of choice if future research can substantiate our study findings.

Applying an explainable machine learning model might reduce the number of negative appendectomies in pediatric patients with a high probability of acute appendicitis

The diagnosis of acute appendicitis and concurrent surgery referral is primarily based on clinical presentation, laboratory and radiological imaging. However, utilizing such an approach results in as much as 10–15% of negative appendectomies. Hence, in the present study, we aimed to develop a machine learning (ML) model designed to reduce the number of negative appendectomies in pediatric patients with a high clinical probability of acute appendicitis. The model was developed and validated on a registry of 551 pediatric patients with suspected acute appendicitis that underwent surgical treatment. Clinical, anthropometric, and laboratory features were included for model training and analysis. Three machine learning algorithms were tested (random forest, eXtreme Gradient Boosting, logistic regression) and model explainability was obtained. Random forest model provided the best predictions achieving mean specificity and sensitivity of 0.17 ± 0.01 and 0.997 ± 0.001 for detection of acute appendicitis, respectively. Furthermore, the model outperformed the appendicitis inflammatory response (AIR) score across most sensitivity–specificity combinations. Finally, the random forest model again provided the best predictions for discrimination between complicated appendicitis, and either uncomplicated acute appendicitis or no appendicitis at all, with a joint mean sensitivity of 0.994 ± 0.002 and specificity of 0.129 ± 0.009. In conclusion, the developed ML model might save as much as 17% of patients with a high clinical probability of acute appendicitis from unnecessary surgery, while missing the needed surgery in only 0.3% of cases. Additionally, it showed better diagnostic accuracy than the AIR score, as well as good accuracy in predicting complicated acute appendicitis over uncomplicated and negative cases bundled together. This may be useful in centers that advocate for the conservative treatment of uncomplicated appendicitis. Nevertheless, external validation is needed to support these findings.

Magnetic resonance imaging for acute appendicitis in pregnancy: can clinical scores predict when imaging is needed?

Advanced imaging may augment the diagnostic milieux for presumed acute appendicitis (AA) during pregnancy, however it is not clear when such imaging modalities are indicated. The aim of this study was to assess the sensitivity and specificity of clinical scoring systems with the findings on magnetic resonance imaging (MRI) of AA in pregnant patients. A retrospective cohort study between 2019 and 2021 was performed in two tertiary level centers. Pregnant patients presenting with suspected AA and non-diagnostic trans-abdominal ultrasound who underwent MRI as part of their evaluation were identified. Patient demographics, parity, gestation, presenting signs, and symptoms were documented. The Alvarado and Appendicitis Inflammatory Response (AIR) score for each patient were calculated and correlated with clinical and MRI findings. Univariate analysis was used to identify factors associated with AA on MRI. Of the 255 pregnant patients who underwent MRI, 33 (13%) had findings of AA. On univariate analysis, presentation during the second/third trimester, migration of pain, vomiting and RLQ tenderness correlated with MRI findings of AA. Whilst 5/77 (6.5%) of patients with an Alvarado score ≤4 had signs of AA on MRI, a score of ≥5 had a sensitivity, specificity, negative and positive predictive value of 84.8%, 36.6%, 94.0% and 17.2%. For an AIR score ≥ 5, this was 78.8%, 41.5%, 93.0%, and 16.7%, respectively. Whilst clinical scoring systems may be useful in identifying which pregnant patients require MRI to be performed when AA is suspected, the low sensitivity implies further research is needed to refine the use of this valuable resource.

Evaluation of clinical examination and preoperative imaging in patients with right iliac fossa pain and a medium or high risk score for appendicitis (RIFT-2)

Introduction: Clinical risk models can be used to safely stratify UK patients with suspected appendicitis with low scores to ambulatory pathways, preventing admissions and unnecessary surgery. This study aimed to examine the diagnostic pathways in patients with medium or high risk scores.
 Methods: This prospective cohort study included patients admitted with suspected appendicitis in the UK. Patients aged ≥16 years were included if they had a medium or high risk score for appendicitis (Appendicitis Inflammatory Response score >2 in men, Adult Appendicitis Score >8 in women). The primary outcome measure was the normal appendicectomy rate (NAR). The AIRS and AAS risk prediction models were validated against pre-determined criteria.
 Results: This UK study included 2,231 women and 1,958 men. Overall, 57.7% of patients underwent surgery. The NAR was 18.4% in women aged 16-45 years, 9.5% in men aged 16-45 years, 4.5% in women aged ≥46 years, and 2.1% in men aged ≥46 years. Risk prediction models did not achieve the pre-determined threshold to be used to identify patients with appendicitis. Ultrasound was the most common imaging modality in women aged 16-45 years, whereas CT was most common in the other subgroups. CT was performed in 12.8% women aged 16-45 years, 21.1% in men aged 16-45 years, 69.3% in women aged ≥46 years, and 74.5% in men aged ≥46 years. The overall NAR in patients who had CT imaging alone (3.6%) was lower than in patients who had no imaging (12.4%) or ultrasound imaging alone (19.0%).
 Conclusion: Patients with right iliac fossa pain should be risk scored, with low-risk patients triaged to ambulatory management and medium and high-risk patients routinely CT scanned. Normal appendicectomy should become a specific therapeutic option rather than a chance finding.

Validation of the Appendicitis Inflammatory Response (AIR) score during pregnancy: A nested case-control study.

Appendicitis poses diagnostic challenges. A correct diagnosis is important during pregnancy to avoid unnecessary surgery on the one hand and delayed surgery on the other hand, as both may negatively affect pregnancy outcomes. Clinical scores for risk-stratified management of suspected appendicitis are well established in adults but have not been validated during pregnancy. This nested case-control study evaluated the diagnostic accuracy of the Appendicitis Inflammatory Response (AIR) score and imaging during pregnancy. By cross-linking national Swedish health registries from a defined geographical area, we identified a cohort of 154 women who underwent appendectomy for suspected appendicitis during pregnancy and a matched cohort of 232 pregnant women admitted for acute abdominal pain and suspected appendicitis but with a discharge diagnosis of nonspecific abdominal pain (NSAP). All variables were extracted from medical records. The diagnostic value of AIR score and imaging was estimated for patients with a final diagnosis of appendicitis compared with patients with negative appendectomy and NSAP patients. The final diagnoses for the operated patients were uncomplicated and complicated appendicitis in 49.4% and 26.6%, respectively, and negative appendectomy in 24.0%. Nearly half of all the patients underwent diagnostic imaging (41%), mainly by ultrasonography. The sensitivity and specificity of diagnostic imaging were 44.9% (95% CI 32.9%-57.4%) and 42.2% (95% CI 31.9%-53.1%), respectively. The area under the receiver operating characteristic curve of AIR score was 0.88 (95% CI 0.84-0.92) for all appendicitis and 0.90 (95% CI 0.84-0.95) for complicated appendicitis. The sensitivity for complicated appendicitis was 100% at a score of ≥4. The specificity for all appendicitis was 97% at a score of ≥9. The results of this study suggest that the AIR score may be a suitable diagnostic tool for risk stratification of pregnant women with abdominal pain and suspected appendicitis but further validation among pregnant women is needed.

Comparative Study of Diagnostic Accuracy of Pelviabdominal Computed Tomography with Contrast versus Appendicitis Inflammatory Response Score in the Diagnosis of Acute Appendicitis

Comparative Study of Diagnostic Accuracy of Pelviabdominal Computed Tomography with Contrast versus Appendicitis Inflammatory Response Score in the Diagnosis of Acute Appendicitis

APPENDICITIS INFLAMMATORY RESPONSE SCORE FOR DIAGNOSIS OF ACUTE APPENDICITIS AS COMPARED TO ALVARADO SCORE

Background: Acute appendicitis was first described by Reginald. H. Fitz in 1886. It is the most frequent cause of acute abdominal pain requiring surgical intervention. Annually appendectomy is the most common abdominal operation performed on emergency basis. Lifetime risk for developing acute appendicitis is 8.6% in men and 6.7% in women. Acute Appendicitis inciting event in most instances is obstruction of the appendix lumen. Acute Appendicitis is classified as catarrhal phlegmonus, gangrenous and perforated. This classification describes the evolutionary stage of disease. Acute appendicitis is more of a clinical diagnosis present as pain abdomen with classical migration from peri-umbilical region to right iliac fossa in 75% of patient nausea and anorexia. Clinical signs are mostly pyrexia, localized tenderness in the right iliac fossa, muscle guarding and rebound tenderness. Laboratory and radiological investigation are also important tool for the diagnosis. Scoring system have been designed to aid in the clinical assessment of patient with acute appendicitis. The most used scoring is the Alvarado score is best performing in validation studies. Alvarado score doesnt incorporate C reactive protein as a variable, many studies shows the importance of C reactive protein in assessment of patient with appendicitis. Objective: Appendicitis Inflammatory Response score as a diagnostic tool for acute appendicitis in our hospital setting. Study design: A Prospective Study. Study period: October 2016 – September 2018. Study setting: Department of General Surgery, Justice K. S. Hegde charitable hospital. Study population: Patients admitted with signs and symptoms of acute appendicitis at Justice K.S. Hegde charitable Hospital, Mangalore. Sample size: 123 patients using epiinfo software for diagnostic test with PPV 64% with article reference (12) confidence interval of 95% and power of study at 80%. Study group: Patients clinically diagnosed with acute appendicitis and giving consent for the study. Methodology: The present study was conducted in the Department of General surgery, Justice K.S. Hegde charitable Hospital Mangalore, in 123 patients, of any age, who were admitted with complaint of acute appendicitis. Patients included in the study were finally correlate with the histopathological report. Result: The maximum patients were in the age group of 11-20 year compromising around 30.9%. Most of the patients were female around 56.1%. Histopathological report showed around 82.1% as Acute appendicitis, 6.5% acute on chronic, recurrent appendicitis 8.9%, chronic appendicitis, granulomatous appendicitis & lymphoid hyperplasia of appendix were .8% each. AIR classified around 46.3% in low probability, 48% indeterminate and 5.7% in high probability group. Alvarado classified around 3.3% in unlikely, 51.2% in possible diagnosis, 37.4% acute and 8.1% in definite group. On spearman correlation coefficient there was found to be a strong positive correlation between both the scoring system and statistically significant p value of 0.0001. AIR score showed a sensitivity of 56.44% and specificity of 59.09% at score >4. Alvarado had a sensitivity of 98.02 % and specificity of 9.09% at score >4. Alvarado and AIR showed 9.90% and 6.93% at score >8 respectively. The specificity of Alvarado and AIR was 100% respectively. The AIR at a low and higher score had a high PPV and NPV, that may help in correctly diagnosing the patient with acute appendicitis and ruling out from non- appendicitis patient. Conclusion: 1. Alvarado score is better diagnostic tool for acute appendicitis as compared to the AIR score. 2. Alvarado score has higher sensitivity in score of >4 as compared to AIR. 3. AIR score with low sensitivity has low discriminatory power in ruling out patient with acute appendicitis.

The Efficacy of Appendicitis Inflammatory Response Score in Diagnosis of Acute Appendicitis

Background: Acute appendicitis is one of the most common cause of acute abdominal pain. The management of suspected appendicitis represents a prime target for improved decision-making in emergency surgical care (OPD, Emergency room). The aim of the work is to evaluate the appendicitis inflammatory response (AIR) score and compare its performance in predicting the risk of appendicitis to the Alvarado score. Objective: To evaluate the diagnostic performance of the AIR score and potential benefits of risk stratification to guide clinical decision making. Methods: This prospective observational study was conducted in the OPD and Emergency department, Sir Salimullah Medical College & Mitford Hospital, Dhaka. From June’2021 to May’2022. A total 240 patients with right lower abdominal pain. History, clinical examination, hematological, radiological investigations were done. AIR score was calculated. Considering histopathology report as gold standard the score was compared. Histopathology report was done in Pathology Department of SSMC, Dhaka. Results: Right iliac fossa pain (100%) was the most common symptom, followed by vomiting (58.3%), temperature (29.5%), and rebound tenderness. After applying AIR scorings, 44(18.3%) patients in low-risk group (0-4), 112(46.7%) patients in the intermediate risk group (5-8) and 84(35.0%) patients in the high-risk category (9-12). Amongst the 240 applying the AIR score, Sensitivity of inflammatory response score vs histopathology findings was 97.9%, specificity 78.4%, accuracy 93.8%, positive and negative predictive values were 94.4% and 90.9% respectively. Conclusion: Risk stratification of patients with suspected appendicitis by the AIR score could guide decision-making to reduce admissions, length of hospital stay, cost and case fatality rate, optimize utility of diagnostic imaging and to decrease negative exploration. Sir Salimullah Med Coll J 2023; 31: 47-52

Clinical characteristics and application value of risk prediction models of acute appendicitis in rural Tibet: a retrospective study.

Acute appendicitis is the most common general surgical emergency worldwide; however, its diagnosis remains challenging, particularly in rural or remote areas such as Tibet. This study aimed to investigate the clinical characteristics and applicability of the routine risk prediction models of acute appendicitis for rural Tibetan populations. Data of patients who underwent appendectomy at the Chaya People's Hospital between 1 April 2018 and 30 September 2021 were retrospectively collected. Multivariate logistic regression analysis was performed to identify risk factors associated with complicated appendicitis. The appendicitis risk prediction model scores for each patient were calculated by the binary logistic regression model based on the data. The index of union method was applied to identify the optimal cut-off value for the critical values of risk prediction models. We included 127 patients with suspected acute appendicitis in the study, consisting of 96 surgically and 31 non-surgically treated. The diagnoses of 93 patients who underwent appendectomy included 55 (59.1%) cases of uncomplicated appendicitis. Patients with complicated appendicitis had a significantly longer postoperative hospital stay (11.0 (interquartile range 8.8-13.3) days v 8.0 (interquartile range 6.0-11.0) days; p<0.001) and higher hospital costs (US$2147.2 (interquartile range US$1625.1-2516.6) v US$1487.9 (interquartile range US$1202.6-1809.2); p24 hours, age >30 years, and male sex were independent risk factors associated with complicated appendicitis. The appendicitis inflammatory response score showed the best performance among the prediction models. Incorporating imaging features in the prediction models may provide better diagnostic value for appendicitis. Acute appendicitis in the rural Tibetan population has unique clinical features. To reduce the incidence of complicated appendicitis, local health workers must balance religious beliefs and professional services for residents.

The Effectiveness of Appendicitis Inflammatory Response Score in the Evaluation of Acute Appendicitis: A Meta-analysis

The Effectiveness of Appendicitis Inflammatory Response Score in the Evaluation of Acute Appendicitis: A Meta-analysis

Performance and diagnostic accuracy of scoring systems in adult patients with suspected appendicitis.

This study aims to determine the most accurate appendicitis scoring system and optimal cut-off points for each scoring system. This single-centred prospective cohort study was conducted from January-to-June 2021, involving all patients admitted on suspicion of appendicitis. All patients were scored according to the Alvarado score, Appendicitis Inflammatory Response (AIR) score, Raja Isteri Pengiran Anak Saleha (RIPASA) score and Adult Appendicitis score (AAS). The final diagnosis for each patient was recorded. Sensitivity and specificity were calculated for each system. Receiver operating characteristic (ROC) curve was constructed for each scoring system, and the area under the curve (AUC) was calculated. Optimal cut-off scores were calculated using Youden's Index. A total of 245 patients were recruited with 198 (80.8%) patients underwent surgery. RIPASA score had higher sensitivity and specificity than other scoring systems without being statistically significant (sensitivity 72.7%, specificity 62.3%, optimal score 8.5, AUC 0.724), followed by the AAS (sensitivity 60.2%, specificity 75.4%, optimal score 14, AUC 0.719), AIR score (sensitivity 76.7%, specificity 52.2%, optimal score 5, AUC 0.688) and Alvarado score (sensitivity 69.9%, specificity 62.3%, optimal score 5, AUC 0.681). Multiple logistic regression revealed anorexia (p-value 0.018), right iliac fossa tenderness (p-value 0.005) and guarding (p-value 0.047) as significant clinical factors independently associated with appendicitis. Appendicitis scoring systems have shown moderate sensitivity and specificity in our population. The RIPASA scoring system has shown to be the most sensitive, specific and easy-to-use scoring system in the Malaysian population whereas the AAS is most accurate in excluding low-risk patients.

Referrals for Pediatric Appendicitis to a Tertiary Care Children's Hospital.

This study aimed to analyze pediatric referrals for definite or possible appendicitis, to compare clinical predictors and laboratory values between patients with and without a final diagnosis of appendicitis, and to determine the accuracy of prereferral diagnostic interpretations of computed tomography scans, ultrasound, and magnetic resonance imaging modalities. We conducted a retrospective analysis of pediatric patients referred from 2015 to 2019 to a tertiary care children's emergency department with definitive or possible appendicitis. Data abstracted included patient demographics, clinical symptoms, physical examination findings, laboratory results, and diagnostic imaging findings (by the referring center and the pediatric radiologist at the accepting center). An Alvarado and Appendicitis Inflammatory Response (AIR) score was calculated for each patient. Analysis was performed on 381 patients; 226 (59%) had a final diagnosis of appendicitis. Patients with appendicitis were more likely to have symptoms of nausea ( P < 0.0001) and vomiting ( P < 0.0001), have a higher mean temperature ( P = 0.025), right lower quadrant abdominal pain to palpation ( P = <0.0001), rebound tenderness ( P < 0.0001), a higher mean Alvarado score [5.35 vs 3.45 ( P < 0.0001)], and a higher mean AIR score [4.02 vs 2.17 ( P < 0.0001)]. Of the 97 diagnostic images initially interpreted as appendicitis by the referring center, 10 (10.3%) were read as no evidence of appendicitis. Of the 62 diagnostic images initially interpreted as "possible appendicitis" by the referring center, 34 (54.8%) were read as no evidence of appendicitis. Of those diagnostic images initially interpreted as "appendicitis" or "possible appendicitis" by the referring center, 24/89 (27.0%) of computed tomography scans, 17/62 (27.4%) of ultrasounds, and 3/8 (37.5%) of magnetic resonance imaging results were read as no evidence of appendicitis. Usage of established scoring algorithms, such as Alvarado and AIR, may decrease the unnecessary cost of diagnostic imaging and transfer to tertiary care. Virtual radiology consultations may be 1 potential solution to improve the referral process for pediatric appendicitis if initial interpretation is uncertain.

A prospective comparative study among Alvarado score, appendicitis inflammatory response (AIR) score, and adult appendicitis score (AAS) in the diagnosis of acute appendicitis in adults

Background Acute appendicitis (AA) is the most common condition presenting with acute abdomen requiring emergency surgery. Several clinical scores were developed to diagnose AA. Aim This study aimed to compare the diagnostic accuracy of three clinical scores (Alvarado score, appendicitis inflammatory response (AIR) score, and adult appendicitis score (AAS)) in the diagnosis of AA. Methods This prospective study was conducted on 100 adult patients (aged ≥ 18 years) presenting with acute abdomen suspicious of noncomplicated AA. Patients with complicated AA (abscess, mass, or diffuse peritonitis) and patients with uncomplicated AA subjected to nonoperative management (NOM) were excluded from our study. The histopathological results were used as the gold standard for diagnosis of AA to which the three clinical scores results were compared. Results Our study included 100 patients (60 males and 40 females), all of whom, had histopathologically proven AA. Due to this outcome, we could only conclude and compare the sensitivities of the three scores. Alvarado score had the highest overall sensitivity (91% at cut-off value &gt; 4 points), followed by AAS (80% at cut-off value &gt; 10 points), then AIR score (71% at cut-off value &gt; 4 points) however, the difference between Alvarado score and AAS was not statistically significant. In males, the Alvarado score had the highest sensitivity (88.3%), followed by AAS (86.7%), then the AIR score (71.7%) at the same cut-off values however, the difference between the Alvarado score and AAS was also not statistically significant. In females, Alvarado score had the highest sensitivity (95%) followed by AAS and AIR scores (70% for both) with a statistically significant difference. Obesity did not influence the outcome of the three scores. Conclusions Alvarado score and AAS are more sensitive than the AIR score. In relation to sex, Alvarado’s score is the most sensitive in females.

Predicting Role of the Appendicitis Inflammatory Response Score in Diagnosis and Risk Stratification of Acute Appendicitis among Adult Patients

Background: Appendicitis is a global disease. Understanding the global evolution of appendicitis in highly industrialized countries and in newly industrialized countries is necessary for planning healthcare resource utilization. Scoring systems have been designed to aid in the clinical assessment of patients with acute appendicitis. The recently introduced Appendicitis Inflammatory Response (AIR) score was designed to overcome these drawbacks. This simple clinical score can correctly classify the majority of patients with suspected appendicitis. To evaluate the AIR score on patients with suspicion of acute appendicitis and its risk stratification and assess the sensitivity and specificity of the AIR score. Materials and methods: This descriptive of observational study was carried out in the Department of Surgery, Chittagong Medical College Hospital, Chattogram from 21st March to 20th September 2017. Total 100 cases of appendicitis patients were selected after careful history taking, thorough general and local examination and appropriate investigations fulfilling inclusion and exclusion criteria. Results: The present study of 100 selected cases reveals that maximum number of patients (54.0%) were between 15-25 years age group, mean age of appendicitis was 24.5±8.9 years. The sensitivity and Specificity of the Appendicitis Inflammatory Response Score (AIR score) in diagnosis and risk stratification of acute appendicitis was 85.2% and 96.9% respectively. Similarly, the positive predictive value and accuracy rate for the same is 93.5 % and 93.0% respectively. Conclusion: Through associating easily applicable clinical criteria and two simple laboratory tests AIR score help in diagnosis and risk stratification of suspected appendicitis and could guide decision-making to reduce admissions, optimize utility of diagnostic imaging and prevent negative explorations. IAHS Medical Journal Vol 5(2), Dec 2022; 46-51

Comparison of the Laparoscopic Appendicitis (LAPP) score with the Alvarado and Appendicitis Inflammatory Response(AIR) scores and computed tomography and pathology results

Background: Acute appendicitis is the most commonly encountered and operated group among general surgery emergency patients. Various scoring and algorithms are used in diagnosis and treatment. This study aimed to compare the Laparoscopic Appendicitis (LAPP) score, which is used to reduce negative appendectomy, according to the pathology and preoperative computed tomography results and investigate its correlation with other clinical scoring systems. Methods: Patients who underwent appendectomy in our clinic between June 2020 and March 2021 were retrospectively reviewed. The obtained LAPP scores were compared with the preoperative imaging results, Alvarado score, appendicitis inflammatory response (AIR) score, and pathology results. Results: The study included a total of 109 patients, of whom 22 (20.18%) had a pathology result that was not consistent with appendicitis. The LAPP score was determined as 1.41 for this 22 patients who underwent negative appendectomy (p&lt;0.001), 2.45 for 74 patients with suppurative appendicitis (p&lt;0.001), and 3.54 for 13 patients with gangrenous or perforated appendicitis (p&lt;0.001). Conclusions: The purpose of the LAPP score is to reduce the rate of negative appendectomy. Appendectomy is also performed in some patients who may have spontaneous resolution if they present to the hospital in the early period. We also consider that the frequency of familial Mediterranean fever in Turkey may be another reason for the high rate of negative appendectomy. In addition, the correlation of high Alvarado and AIR scores with a high LAPP score indicates that it is more reliable in the diagnosis of complicated appendicitis.

Evaluation and Comparison of the Accuracy and Efficacy of Alvarado and Appendicitis Inflammatory Response Scoring in Acute Appendicitis

INTRODUCTION&#x0D; Acute appendicitis (AA) is one of the most common causes of acute abdominal pain. Early surgery for acute appendicitis may lead to inadequate evaluation of differential diagnoses of acute abdominal pain and increases the chances of negative appendectomy, whereas delaying it leads to potential complications. Appendicitis inflammatory response (AIR) score, has been created to overcome shortcomings of the Alvarado score. In this, a mathematical model focused on detecting perforated appendicitis has been used. Unlike previously reported scores, this included C-reactive protein (CRP), which had been previously reported to have high accuracy in discriminating between simple and advanced acute appendicitis.&#x0D; MATERIAL AND METHODS&#x0D; Observational Cross sectional study was done in all patients admitted to UCMS hospital diagnosed to have acute appendicitis from October 2019 to March 2021. The primary objective was to determine if use of Appendicitis Inflammatory Response Score is better suited for planning management of patients with acute appendicitis. Comparison between groups was done with one-way Analysis of Variance (ANOVA). Receiver Operating Curve (ROC) was used to identify whether Appendicitis inflam- matory response (AIR) score or Alvarado score was good predictor of acute appendicitis. Sensitivity, Specificity and Area under Curve (AUC) was used as indicators to predict the acute appendicitis.&#x0D; RESULTS&#x0D; In our study, the sensitivity of Appendicitis inflammatory response (AIR) score is high (85.4%) as compared to 82.3% of Alvarado score.&#x0D; CONCLUSION&#x0D; We concluded that Appendicitis inflammatory response (AIR) score is more reliable scoring system for the diagnosis of acute appendicitis and its use can be justified over the pre-existing Alvarado scoring.&#x0D;

Does one of the two most commonly used scoring systems have a decisive advantage over the other in diagnosing acute appendicitis in pregnant women?

This study aimed to compare the accuracy and reliability of Alvarado Score (AS) and Appendicitis Inflammatory Response Score (AIRS) in pregnant women undergoing surgery for acute appendicitis (AA). The files of 53 pregnant women with a diagnosis of AA who underwent surgery in our clinic between February 2014 and December 2018 were examined retrospectively. The patients were divided into 3 groups as follows: first trimester between 0 and 14 weeks, second trimester between 15 and 28 weeks, and third trimester between 29 and 42 weeks. The AS and AIRS values were calculated according to preoperative physical examination and laboratory results. The mean age of the patients was 28.58 (18-44) years. According to the pathology results, appendicitis was detected in 16 of 23 patients in the first trimester, in 22 of 25 patients in the second trimester, and in 2 of 5 patients in the third trimester. The AIRS was ≥ 9 in 9 patients and the AS was ≥ 7 in 19 of the 23 patients in the 1st trimester, while the AIRS was ≥ 9 in 11 patients and the AS was ≥ 7 in 19 of the 25 patients in the 2nd trimester. However, in the 3rd trimester, the AIRS was ≥ 9 in 2 patients and AS was ≥ 7 in 4 of the 5 patients. In conclusion, when the data obtained from the present study were evaluated, it was determined that both AS and AIRS are effective methods for diagnosing AA in pregnant women.

Evaluation of Diagnostic Accuracy of Alvarado, Appendicitis Inflammatory Response and Adult Appendicitis Scoring System in Diagnosing Acute Appendicitis: A Prospective Cohort Study

Introduction: Appendicitis is one of the most common surgical emergencies, but its clinical diagnosis is still a big challenge for surgeons to decrease the negative appendectomy rate. Aim: To validate and compare alvarado, Appendicitis Inflammatory Response (AIR) score and adult appendicitis scoring system in diagnosing acute appendicitis. Materials and Methods: A prospective cohort study was conducted in the Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India, from December 2020 to May 2022 on 100 patients who were clinically suspected of acute appendicitis. All three scores {AIR, Adult Appendicitis Score (AAS), Alvarado} were calculated. Diagnostic tests were used to calculate sensitivity, specificity, Negative Predictive Value (NPV) and Positive Predictive Value (PPV). DeLong test were used to compare the area under the curve of three scores with each other for predicting acute appendicitis and the final result was compared with the histopathological report. The data was presented as numbersvand percentage and the p-value &lt;0.05 was considered statistically significant. Results: The mean age of study subjects was 30.28±10.9 years. It was found that the AIR score had more sensitivity (92.55%), followed by the AAS (84.04%) score and Alvarado (60.64%) score for diagnosing acute appendicitis but the specificity of the Alvarado score was highest (100%), followed by AAS (83.33%) and AIR (66.67%) score. AIR score had more NPV (36.40%) as compared to AAS (25%) and Alvarado score (14%). The diagnostic accuracy of AIR (91%) was higher than AAS and Alvarado’s score 84% and 63%, respectively. Conclusion: Appendicitis Inflammatory Response (AIR) score and AAS can be used over Alvarado score for better diagnosis of acute appendicitis in emergency patients and to reduce the rate of negative appendectomy.

Comparison of Alvarado score, appendicitis inflammatory response score (AIR) and Raja Isteri Pengiran Anak Saleha appendicitis (RIPASA) score in predicting acute appendicitis

IntroductionAcute Appendicitis is the most common surgical emergency encountered in emergency departments. To prevent the rate of negative appendectomies, different systems i.e. Alvarado score and Appendicitis Inflammatory Response Score (AIR) scores were used, but their diagnostic accuracy in Asian population is questionable. Raja Isteri Pengiran Anak Saleha (RIPASA) score has showed promising results in the recent literature. The purpose of this study is to compare the efficacy of Alvarado, AIR and RIPASA scores in the diagnosis of acute appendicitis. MethodsAlvarado, AIR and RIPASA scores were prospectively applied to 132 included patients that were admitted with provisional diagnosis of acute appendicitis and then their surgery was performed in General Surgery Unit, Hayatabad Medical Complex Peshawar, Pakistan from 1st January 2022 to 31st July 2022. Final diagnosis was confirmed by histopathology report and scores were correlated with final report. Cut off value of score >7, >5 and >7.5 were set for Alvarado, AIR and RIPASA score, respectively according to previous literature. Statistics analysis was done for all 3 scoring systems on SPSS version 23. ResultsOf 132 patients, there were n = 79(59.8%) males and n = 53(40.2%) females. Mean age was 24 years (SD ± 11.6) with youngest patient of 9 years and oldest one was 70 years old. Negative Appendectomy rate was 8.3%(n = 11). RIPASA score was superior to AIR and Alvarado score in Sensitivity, NLR, Accuracy and Area under the Curve. AIR score performed better in specificity, NPV, PLR compared to RIPASA and Alvarado score. ConclusionRIPASA score is an overall better scoring system in diagnosing acute appendicitis in compared to Alvarado and AIR score.

Evaluation of Alvarado score and appendicitis inflammatory response score as diagnostic tools for acute appendicitis

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.