Abstract
Background
Patients presenting with suspected appendicitis pose a diagnostic challenge. The appendicitis inflammatory response (AIR) score has outperformed the Alvarado score in two retrospective studies. The aim of this study was to evaluate the AIR Score and compare its performance in predicting risk of appendicitis to both the Alvarado score and the clinical impression of a senior surgeon.
Methods
All parameters included in the AIR and Alvarado scores as well as the initial clinical impression of a senior surgeon were prospectively recorded on patients referred to the surgical on call team with acute right iliac fossa pain over a 6-month period. Predictions were correlated with the final diagnosis of appendicitis.
Results
Appendicitis was the final diagnosis in 67 of 182 patients (37 %). The three methods of assessment stratified similar proportions (~40 %) of patients to a low probability of appendicitis (p = 0.233) with a false negative rate of <8 % that did not differ between the AIR score, Alvarado score or clinical assessment. The AIR score assigned a smaller proportion of patients to the high probability zone than the Alvarado score (14 vs. 45 %) but it did so with a substantially higher specificity (97 %) and positive predictive value (88 %) than the Alvarado score (76 and 65 %, respectively).
Conclusions
The AIR score is accurate at excluding appendicitis in those deemed low risk and more accurate at predicting appendicitis than the Alvarado score in those deemed high risk. Its use as the basis for selective CT imaging in those deemed medium risk should be considered.
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Addiss DG, Shaffer N, Fowler B et al (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132:910–925
McCartan DP, Fleming FJ, Grace PA (2010) The management of right iliac fossa pain—is timing everything? Surgeon 8:211–217
Alvarado A (1986) A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 15:557–564
Owen TD, Williams H, Stiff G et al (1992) Evaluation of the Alvarado score in acute appendicitis. J R Soc Med 85:87–88
Ohmann C, Yang Q, Franke C (1995) Diagnostic scores for acute appendicitis. Abdominal Pain Study Group. Eur J Surg 161:273–281
Ohle R, O’Reilly F, O’Brien KK et al (2011) The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med 9:139
Andersson M, Andersson RE (2008) The appendicitis inflammatory response score: a tool for the diagnosis of acute appendicitis that outperforms the Alvarado score. World J Surg 32:1843–1849. doi:10.1007/s00268-008-9649-y
Yu C-W, Juan L-I, Wu M-H et al (2013) Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis. Br J Surg 100:322–329
De Castro SMM, Ünlü C, Steller E et al (2012) Evaluation of the appendicitis inflammatory response score for patients with acute appendicitis. World J Surg 36:1540–1545. doi:10.1007/s00268-012-1521-4
Sporn E, Petroski GF, Mancini GJ et al (2009) Laparoscopic appendectomy–is it worth the cost? Trend analysis in the US from 2000 to 2005. J Am Coll Surg 208:179–185
Anderson BA, Salem L, Flum DR (2005) A systematic review of whether oral contrast is necessary for the computed tomography diagnosis of appendicitis in adults. Am J Surg 190:474–478
Krajewski S, Brown J, Phang PT et al (2011) Impact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: a meta-analysis. Can J Surg 54:43–53
Rao PM, Rhea JT, Novelline RA et al (1998) Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med 338:141–146
Shah DJ, Sachs RK, Wilson DJ (2012) Radiation-induced cancer: a modern view. Br J Radiol 85:e1166–e1173
Wells PS, Hirsh J, Anderson DR et al (1995) Accuracy of clinical assessment of deep-vein thrombosis. Lancet 345:1326–1330
Gage BF, van Walraven C, Pearce L et al (2004) Selecting patients with atrial fibrillation for anticoagulation: stroke risk stratification in patients taking aspirin. Circulation 110:2287–2292
Gwynn LK (2001) The diagnosis of acute appendicitis: clinical assessment versus computed tomography evaluation. J Emerg Med 21:119–123
Hong JJ, Cohn SM, Ekeh AP et al (2003) A prospective randomized study of clinical assessment versus computed tomography for the diagnosis of acute appendicitis. Surg Infect (Larchmt) 4:231–239
Acknowledgments
We wish to acknowledge the invaluable assistance of Dr Michael Harrison (Waterford Institute of Technology) for the statistical support for calculation of ROC curves and McNemars test.
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Kollár, D., McCartan, D.P., Bourke, M. et al. Predicting Acute Appendicitis? A comparison of the Alvarado Score, the Appendicitis Inflammatory Response Score and Clinical Assessment. World J Surg 39, 104–109 (2015). https://doi.org/10.1007/s00268-014-2794-6
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DOI: https://doi.org/10.1007/s00268-014-2794-6