Evaluation of Diagnostic Accuracy of Alvarado, Appendicitis Inflammatory Response and Adult Appendicitis Scoring System in Diagnosing Acute Appendicitis: A Prospective Cohort Study

Introduction: Appendicitis is one of the most common surgical emergencies, but its clinical diagnosis is still a big challenge for surgeons to decrease the negative appendectomy rate.

Aim: To validate and compare alvarado, Appendicitis Inflammatory Response (AIR) score and adult appendicitis scoring system in diagnosing acute appendicitis.

Materials and Methods: A prospective cohort study was conducted in the Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India, from December 2020 to May 2022 on 100 patients who were clinically suspected of acute appendicitis. All three scores {AIR, Adult Appendicitis Score (AAS), Alvarado} were calculated. Diagnostic tests were used to calculate sensitivity, specificity, Negative Predictive Value (NPV) and Positive Predictive Value (PPV). DeLong test were used to compare the area under the curve of three scores with each other for predicting acute appendicitis and the final result was compared with the histopathological report. The data was presented as numbers and percentage and the p-value <0.05 was considered statistically significant.

Results: The mean age of study subjects was 30.28±10.9 years. It was found that the AIR score had more sensitivity (92.55%), followed by the AAS (84.04%) score and Alvarado (60.64%) score for diagnosing acute appendicitis but the specificity of the Alvarado score was highest (100%), followed by AAS (83.33%) and AIR (66.67%) score. AIR score had more NPV (36.40%) as compared to AAS (25%) and Alvarado score (14%). The diagnostic accuracy of AIR (91%) was higher than AAS and Alvarado’s score 84% and 63%, respectively.

Conclusion: Appendicitis Inflammatory Response (AIR) score and AAS can be used over Alvarado score for better diagnosis of acute appendicitis in emergency patients and to reduce the rate of negative appendectomy.