A comparative study of appendicitis inflammatory response (AIR) score with Alvarado score in diagnosis of acute appendicitis

Malyar, Aijaz Ahmad; Singh, Baint; Dar, Hanief Mohamed; Ahmad, Muzaffar; Bhat, Shahnawaz Bashir

doi:10.5455/bmmr.180876

Cited by 6 publications

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“…The overall negative appendectomy rate in the study was 15.89%, which was comparable and lower than those of similar studies [ 15 , 16 ]. A study performed in 2005 in the Netherlands found that approximately 15% of the patients underwent a negative appendectomy, and the number was found to be similar to another large Swedish study [ 17 ].…”

Section: Discussionsupporting

confidence: 75%

RIPASA and air scoring systems are superior to alvarado scoring in acute appendicitis: Diagnostic accuracy study

Chisthi

Surendran

Narayanan

2020

Annals of Medicine and Surgery

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Background Acute appendicitis remains difficult-to-diagnose in spite of being a common acute abdominal condition. Early and correct diagnosis is essential either to proceed with early appendectomy or conservative approach so that complications and negative explorations can be minimised. Scoring systems can help in quick diagnosis and decision making. Though the Alvarado scoring is the widely used system, differences in diagnostic accuracy have been observed when it is applied to varied populations. Materials and methods The objective was to find the predictive accuracy of Modified Alvarado score, Appendicitis Inflammatory Response score and Raja Isteri Pengiran Anak Saleha Appendicitis score, in a diagnostic test evaluation study. From first January 2018 to first January 2019, 107 consecutive patients admitted with a diagnosis of suspected appendicitis were assessed with these scores. Sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio and area under curve were determined for each. Results Negative appendicectomy rate was 15.89%. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 64.44%, 58.82%, 89.23%, 23.81% and 63.55% respectively for Modified Alvarado; 97.78%, 29.41%, 88%, 71.43% and 86.92% respectively for Appendicitis Inflammatory Response; 87.78%, 76.47%, 95.18%, 54.17% and 85.98% respectively for Raja Isteri Pengiran Anak Saleha Appendicitis. Area under the curve was 0.726797 for Modified Alvarado, 0.946732 for Appendicitis Inflammatory Response and 0.910131 for Raja Isteri Pengiran Anak Saleha Appendicitis . Conclusion Appendicitis Inflammatory Response score probably is superior to Alvarado in the paediatric population because the variables scored are easy to apply to children, while Alvarado requires children to identify subjective symptoms which may not always be accurate. Appendicitis Inflammatory Response and Raja Isteri Pengiran Anak Saleha Appendicitis are better diagnostic scoring system for acute appendicitis than Modified Alvarado. Also, both these scores can be easily calculated by complete history, detailed clinical examination and basic laboratory investigations.

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Section: Discussionsupporting

confidence: 75%

RIPASA and air scoring systems are superior to alvarado scoring in acute appendicitis: Diagnostic accuracy study

Chisthi

Surendran

Narayanan

2020

Annals of Medicine and Surgery

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“…[14,15] The AIR score has a minimum value of five and a maximum value of 12, and it is presumed to assess the severity of acute appendicitis in relation to leucocytosis, the C-reactive protein and segmented neutrophils. [15] In addition, the AIR score has shown better results than the Alvarado score, [16] which yielded a value greater than four and a sensitivity and specificity of 97% and 77%, respectively, [16] whereas the AIR score had a value greater than 8 and yielded a sensitivity and specifi city of 12% and 100%, respectively. [16] …”

Section: Discussionmentioning

confidence: 99%

“…[15] In addition, the AIR score has shown better results than the Alvarado score, [16] which yielded a value greater than four and a sensitivity and specificity of 97% and 77%, respectively, [16] whereas the AIR score had a value greater than 8 and yielded a sensitivity and specifi city of 12% and 100%, respectively. [16] …”

Section: Discussionmentioning

confidence: 99%

Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis

Shuaib

Fakhra

et al. 2017

World Journal of Emergency Medicine

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BACKGROUND: Acute appendicitis is the most common surgical condition presented in emergency departments worldwide. Clinical scoring systems, such as the Alvarado and modified Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%-10%. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specifi cally for Asian populations. The aim of this study was to compare the modifi ed Alvarado with the RIPASA scoring system in Kuwait population. METHODS:This study included 180 patients who underwent appendectomies and were documented as having "acute appendicitis" or "abdominal pain" in the operating theatre logbook (unit B) from November 2014 to March 2016. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic (ROC) curve of the modified Alvarado and RIPASA scoring systems were derived using SPSS statistical software. RESULTS:A total of 136 patients were included in this study according to our criteria. The cut-off threshold point of the modifi ed Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specifi city of 56%. The PPV was 89.3% and the NPV was 42.4%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded a 94.5% sensitivity and an 88% specifi city. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modifi ed Alvarado and RIPASA scoring systems, respectively. The negative appendectomy rate decreased signifi cantly, from 18.4% to 10.7% for the modifi ed Alvarado, and to 2.2% for the RIPASA scoring system, which was a signifi cant difference (P<0.001) for both scoring systems.CONCLUSION: Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specifi city than the modifi ed Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations. The RIPASA scoring system is more accurate and specific than the modifi ed Alvarado scoring system for Kuwait population.

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“…The AIR score has a minimum value of five and a maximum value of 12, and it is presumed to assess the severity of acute appendicitis in relation to leucocytosis, the C-reactive protein and segmented neutrophils [15]. In addition, the AIR score has shown better results than the Alvarado score, [16] which yielded a value greater than four and a sensitivity and specificity of 97% and 77%, respectively, [16] whereas the AIR score had a value greater than 8 and yielded a sensitivity and specificity of 12% and 100%, respectively [16].…”

Section: Resultsmentioning

confidence: 99%

Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis

Kumar¹,

Snehlata²

2020

Int J Surg Ortho

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Background: Acute appendicitis is the most common surgical condition presented in emergency departments worldwide. Clinical scoring systems, such as the Alvarado and modified Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%-10%. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specifically for Asian populations. The aim of this study was to compare the modified Alvarado with the RIPASA scoring system in Kuwait population. Methods: This study included 90 patients who underwent appendectomies and were documented as having "acute appendicitis" or "abdominal pain" in the operating theatre register from June 2014 to May 2018. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic (ROC) curve of the modified Alvarado and RIPASA scoring systems were derived using SPSS statistical software. Results: A total of 68 patients were included in this study according to our criteria. The cut-off threshold point of the modified Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specificity of 56%. The PPV was 89.3% and the NPV was 42.4%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded a 94.5% sensitivity and an 88% specificity. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modified Alvarado and RIPASA scoring systems, respectively. Conclusion: Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specificity than the modified Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations.

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A comparative study of appendicitis inflammatory response (AIR) score with Alvarado score in diagnosis of acute appendicitis

Cited by 6 publications

References 0 publications

RIPASA and air scoring systems are superior to alvarado scoring in acute appendicitis: Diagnostic accuracy study

RIPASA and air scoring systems are superior to alvarado scoring in acute appendicitis: Diagnostic accuracy study

Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis

Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis

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