Comparison of the use of Alvarado and AIR scores as an adjunct to the clinical diagnosis of acute appendicitis in the pediatric population

Abstract

BackgroundAcute appendicitis is one of the most common causes of acute abdominal pain with an incidence of 1.17 per 1000 and lifetime risk of approximately 7%. It remains the most common indication for emergency abdominal surgery in childhood. Diagnosis of acute appendicitis is particularly difficult in young women and the pediatric population. In the USA, CT imaging is used to avert diagnostic dilemma, however the procedure is associated with radiation risk in this vulnerable population. Additionally, the procedure has high cost and variable availability.MethodsA retrospective study involving all suspected pediatric cases of appendicitis between the ages of 5 and 17 who were operated on between 2012 and 2015 was carried out. Data were collated from clinical notes on age, sex, ultrasound findings; postoperative complications, white cell count, neutrophils, C-reactive protein, histology result, and number of days to theater. All patients in the time period were retrospectively scored on the Alvarado and Appendicitis Inflammatory Response (AIR) scores.ResultsA total of 239 patients between 11 and 17 (mean 13.6±SE) years of age were included in the study. Of these, 79 had preoperative ultrasound, of which 52 were negative, and only one patient had CT scan. 213 of the patients had an appendicectomy and 26 had diagnostic laparoscopy with no appendicectomy. Of the 213 appendixes removed, 71 were histopathologically normal, giving a negative appendectomy rate of 33.3%. 28 appendixes were perforated. The average number of days from admission to theater was 1.0 SE in males and 1.424 in females (p=0.0498). The average number of days from admission to theater in those who had ultrasound was 2.03 days compared with 0.75 in those who did not have ultrasound (p<0.0001). AIR scoring that was high and medium risk showed slightly lower negative appendicectomy rates but not significantly different.ConclusionsOur study has found no significant difference between the AIR scores and Alvarado. There is a role for scoring systems to be used to aid in the decision to undergo imaging and as an adjunct to clinical diagnosis.

Comparison of the appendicitis inflammatory response and Alvarado scoring systems in the diagnosis of acute appendicitis in children

“…However, with due attention to our results, we failed to report an extreme superiority for the AIR scoring system discriminating power in pediatric patients compared to that of the Alvarado system. Although our findings were consistent with a previous study by Musbahi et al , our results were not consistent with the results of Macco et al [ 33 , 34 ]. Also, they revealed a 14% rate of missed appendicitis, which is not only two-fold higher in comparison to the missed cases evaluated by the Alvarado score but also increases the risk of development of life-threatening complications of appendicitis in children.…”

“…To our knowledge, this is one of the first studies which have prospectively compared the accuracy of the AIR and Alvarado scores in the estimation of appendicitis development in pediatric patients [ 33 , 34 ]. According to the study results, both of the scoring systems evaluated in the current survey provide acceptable diagnostic accuracy in ruling out the probability of appendicitis among young individuals due to their higher sensitivity and specificity followed by an acceptable discriminative value.…”

Quality Outcomes in Appendicitis Care: Identifying Opportunities to Improve Care

“…It was pointed out by Anderson that it is recommended to repeat the scoring system during observation of patients with persistent symptoms and biochemical markers to come to a diagnostic decision [ 45 ]. The recent guidelines also suggest that the AIR and the AAS significantly aid in clinical diagnosis and have a potential for reducing negative appendectomy rates as well as limiting the use of imaging [ 10 , 46 , 47 , 48 , 49 ].…”

Uji Diagnostik Rasio Neutrofil-Limfosit Pada Apendisitis Akut Di Rumah Sakit Umum Zainoel Abidin Banda Aceh

“…[6][7][8] RNL dapat digunakan sebagai prediktor proses inflamasi pada apendisitis seperti yang dituliskan pada penelitian Musbahi, Kahramanca dan Dhinakaran. [8][9][10] Ketepatan diagnosis apendisitis yang sulit, masih tingginya misdiagnosis maupun negatif apendektomi, pemeriksaan penunjang yang tersedia membutuhkan keahlian khusus dan belum tentu tersedia di beberapa fasilitas kesehatan, beberapa penelitian mendapatkan penggunaan RNL pada apendisitis akut dapat membantu penegakkan diagnosis dengan ce-J Indon Med Assoc, Volum: 71, Nomor: 4, Agustus -September 2021 pat dan tepat, selain murah dan tidak membutuhkan keahlian khusus dalam pemeriksaan. Sampai saat ini belum ada laporan resmi mengenai uji diagnostik RNL pada apendisitis akut di RSU Zainoel Abidin (RSUZA) Banda Aceh.…”