The Appendicitis Inflammatory Response Score for Acute Appendicitis: Is It Important for Early Diagnosis?

Abstract

- BACKGROUND: The use of Appendicitis Inflammatory Response clinical score in patients with suspected acute appendicitis makes the diagnosis more objective and accurate. AIMS: The aim of this study was to prospectively compare two groups with suspected acute appendicitis, analyzing the number of imaging tests requested, waiting time in the emergency department, until definition of conduct, as well as the sensitivity and specificity of this diagnostic method. METHODS: This is a prospective randomized study comparing 55 patients submitted to clinical-radiological diagnosis according to the routine of the service (control group), with another 55 patients submitted to the Appendicitis Inflammatory Response score flowchart (intervention group). RESULTS: Waiting time for defining the intervention group’s conduct was 1.5 h shorter than the control group (p=0.02). Computed tomography was performed in 42 patients in the control group, compared with 25 in the intervention group (p=0.001). The impact of the flowchart based on the Appendicitis Inflammatory Response score of the cases compared to the control group was the reduction of appendectomies with a normal-appearing appendix from 5 to 1 and an increase in the exclusion of appendicitis diagnoses. The use of the Appendicitis Inflammatory Response score resulted in a diagnostic specificity of 92%, compared to 29% in the control group. CONCLUSIONS: The use of the Appendicitis Inflammatory Response score reduced the waiting time for the diagnosis of acute appendicitis, decreased the number of imaging tests, and increased diagnostic specificity of the disease.

Observation Safely Reduces the Use of the Computerized Tomography in Medium-to-Low-Risk Patients with Suspected Acute Appendicitis: Results of a Randomized Controlled Trial

“…A similar study by Andersson et al used AIR diagnostic score evaluation and successfully decreased the CT use by 44% [ 21 ]. A recently performed prospective randomized study presented a sensitivity of 100% for AIR scores since there were no false-negative AA diagnoses, implying that clinical scores can minimize the number of imaging tests and waiting time for AA diagnosis, while also improving diagnostic accuracy [ 22 ]. Therefore, all patients in our study were evaluated with Alvarado and AIR scores that helped us to detect patients with probable AA.…”

“…It is known that a short, in-hospital surgical delay of up to 24 h is safe in uncomplicated AA and does not increase complications and/or the perforation rate in adults [ 39 ]. Moreover, a comparable study [ 22 ] found the AIR score is safe in predicting the need for surgical treatment for patients with high AIR scores without the need for imaging examination as all these patients in both groups, who initially underwent CT scanning or straightforward surgical treatment, had a histopathologically confirmed diagnosis of acute appendicitis. Based on Andersson and colleagues’ recently performed randomized control trial, 69% of patients with an intermediate AIR score could be treated without any imaging tool [ 21 ].…”

Laparoscopic Appendicectomy: Risk Factors for Conversion to Laparotomy

“…Conversion rate is one of the main factors used to measure laparoscopic competence 5 . The rate of conversion evaluated by many studies was related to various factors and was more associated with higher hospital costs 10 .…”

Diagnosis of Acute Appendicitis and Appendicular Perforation: Evaluation of Platelet Indices and Red Cell Distribution Width as Emerging Biomarkers

“…The diagnosis of acute appendicitis is supported by the use of a variety of clinical grading systems 8 . A clinical scoring system helps improve the first evaluation.…”