Clinical Scores For Acute Appendicitis – Alvarado Score Vs Appendicitis Inflammatory Response Score

Abstract

Background: Acute appendicitis is the most frequent cause of acute abdomen in young adults. Alvarado score is the most commonly used clinical scoring system but has variable specificity and sensitivity. Appendicitis Inflammatory Response (AIR) score has been found better than the older Alvarado score. The rationale of this study was to determine the diagnostic accuracy of two scoring systems which are commonly used in acute appendicitis.

Materials and Methods: 289 patients fulfilling criteria with suspected acute appendicitis were included. Demographic data was recorded. A score of 8 was cut off threshold for AIR and 7 for Alvarado Score. Sensitivity, specificity, positive predictive value (PPV) and negative predictive (NPV) for AIR and Alvarado score were calculated. Specimen were sent for histopathology for final diagnosis. Statistical analysis was done using SPSS version 21.

Results:  Results showed that Alvarado scoring at value > 7 had sensitivity of 53.03%, specificity of 90.45%, PPV of 82.35%, NPV of 69.61% and diagnostic accuracy of 73.36%. Furthermore, AIR scoring > 8 had sensitivity of 51.52%, specificity of 96.82%, PPV of 93.15%, NPV of 70.37% and diagnostic accuracy of 76.12%.

Conclusion:  The diagnostic accuracy of AIR score was 76.12% and diagnostic accuracy of Alvarado score was 73.36%. AIR score has been found to have a higher discriminating power as compared to Alvarado score.