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
