Download PDF
CC BY 4.0 · Surg J (N Y) 2021; 07(03): e127-e131
DOI: 10.1055/s-0041-1731446
Original Article

Appendicitis Inflammatory Response Score in Comparison to Alvarado Score in Acute Appendicitis

Toney Jose 
1   Department of Surgical Gastroenterology, Bangalore Medical College and Research Institute, Bangalore, India
,
PS Rajesh
2   Department of General Surgery, Government Medical College, Kottayam, Kerala, India
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Appendicitis is a common differential diagnosis of right lower quadrant pain. Clinical evaluation alone results in high negative appendicectomy rates. Alvarado scoring is the most commonly used clinical prediction rule. The study aimed to compare the recently developed appendicitis inflammatory response (AIR) score with the Alvarado score. This cross-sectional observational study included patients who underwent appendicectomy for clinical suspicion of appendicitis. The clinical and laboratory parameters required for obtaining Alvarado score and AIRS were gathered. Area under ROC curve was calculated for both Alvarado score and AIRS. The study included 130 patients (77 males and 53 females). The negative appendicectomy rate was 10.7%. The perforation rate was 10.3%. The area under ROC for Alvarado score was 0.821 and for AIR score was 0.901. The Alvarado score had a sensitivity of 72% and a specificity of 79% at score ≥6. The appendicitis inflammatory response score had a sensitivity of 98% for scores ≥5 and a specificity of 97% for score ≥6. The C-reactive protein (CRP) value was the best performing individual parameter with an area under ROC of 0.789, followed by WBC count with an area under ROC of 0.762. Appendicitis inflammatory response score is a recently developed score that outperforms the Alvarado score. AIR score has a higher specificity. The sound construction, gradation of parameters, the inclusion of CRP, and avoidance of subjective parameters make the AIR score an attractive clinical prediction rule which can decrease the rate of negative appendicectomy.

Keywords

appendicitis - clinical prediction rule - Alvarado - appendicitis inflammatory response score

Ethics Approval

Approval was obtained from the Ethics Committee of Govt. Medical College, Kottayam. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.


Consent to Participate

Informed consent was obtained from all individual participants included in the study.


Availability of Data and Material

Yes.


Authors' Contributions

T.J. was involved in the study conception and design, data collection and analysis, and manuscript preparation. R.P.S. was involved in the study conception, design, analysis, and manuscript preparation.




Publication History

Received: 08 April 2021

Accepted: 17 May 2021

Article published online:
19 July 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 McCartan DP, Fleming FJ, Grace PA. The management of right iliac fossa pain - is timing everything?. Surgeon 2010; 8 (04) 211-217
    CrossrefPubMedGoogle Scholar
  • 2 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 (05) 194-197
    CrossrefPubMedGoogle Scholar
  • 3 Velanovich V, Satava R. Balancing the normal appendectomy rate with the perforated appendicitis rate: implications for quality assurance. Am Surg 1992; 58 (04) 264-269
    PubMedGoogle Scholar
  • 4 Andersson R, Hugander A, Thulin A, Nyström PO, Olaison G. Indications for operation in suspected appendicitis and incidence of perforation. BMJ 1994; 308 (6921): 107-110
    CrossrefPubMedGoogle Scholar
  • 5 Bachoo P, Mahomed AA, Ninan GK, Youngson GG. Acute appendicitis: the continuing role for active observation. Pediatr Surg Int 2001; 17 (2-3): 125-128
    CrossrefPubMedGoogle Scholar
  • 6 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 (08) 1843-1849
    CrossrefPubMedGoogle Scholar
  • 7 Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986; 15 (05) 557-564
    CrossrefPubMedGoogle Scholar
  • 8 Nautiyal H, Ahmad S, Keshwani NK, Awasthi DN. Combined use of modified Alvarado score and USG in decreasing negative appendicectomy rate. Indian J Surg 2010; 72 (01) 42-48
    CrossrefPubMedGoogle Scholar
  • 9 Owen TD, Williams H, Stiff G, Jenkinson LR, Rees BI. Evaluation of the Alvarado score in acute appendicitis. J R Soc Med 1992; 85 (02) 87-88
    CrossrefPubMedGoogle Scholar
  • 10 Douglas CD, Macpherson NE, Davidson PM, Gani JS. Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score. BMJ 2000; 321 (7266): 919-922
    CrossrefPubMedGoogle Scholar
  • 11 Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg 2004; 91 (01) 28-37
    CrossrefPubMedGoogle Scholar
  • 12 Ransohoff DF, Feinstein AR. Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. N Engl J Med 1978; 299 (17) 926-930
    CrossrefPubMedGoogle Scholar
  • 13 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 (01) 104-109
    CrossrefPubMedGoogle Scholar
  • 14 Flum DR, Morris A, Koepsell T, Dellinger EP. Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA 2001; 286 (14) 1748-1753
    CrossrefPubMedGoogle Scholar
  • 15 Güller U, Rosella L, McCall J, Brügger LE, Candinas D. Negative appendicectomy and perforation rates in patients undergoing laparoscopic surgery for suspected appendicitis. Br J Surg 2011; 98 (04) 589-595
    CrossrefPubMedGoogle Scholar
  • 16 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; 36 (07) 1540-1545
    CrossrefPubMedGoogle Scholar
  • 17 Macco S, Vrouenraets BC, de Castro SM. Evaluation of scoring systems in predicting acute appendicitis in children. Surgery 2016; 160 (06) 1599-1604
    CrossrefPubMedGoogle Scholar
  • 18 Andersson M, Kolodziej B, Andersson RE. STRAPPSCORE Study Group. Randomized clinical trial of Appendicitis Inflammatory Response score-based management of patients with suspected appendicitis. Br J Surg 2017; 104 (11) 1451-1461
    CrossrefPubMedGoogle Scholar
  • 19 Scott AJ, Mason SE, Arunakirinathan M, Reissis Y, Kinross JM, Smith JJ. Risk stratification by the Appendicitis Inflammatory Response score to guide decision-making in patients with suspected appendicitis. Br J Surg 2015; 102 (05) 563-572
    CrossrefPubMedGoogle Scholar
  • 20 Frountzas M, Stergios K, Kopsini D, Schizas D, Kontzoglou K, Toutouzas K. Alvarado or RIPASA score for diagnosis of acute appendicitis? A meta-analysis of randomized trials. Int J Surg 2018; 56: 307-314
    CrossrefPubMedGoogle Scholar
  • 21 Chisthi MM, Surendran A, Narayanan JT. RIPASA and air scoring systems are superior to Alvarado scoring in acute appendicitis: diagnostic accuracy study. Ann Med Surg (Lond) 2020; 59: 138-142
    CrossrefPubMedGoogle Scholar