A prospective comparative study among Alvarado score, appendicitis inflammatory response (AIR) score, and adult appendicitis score (AAS) in the diagnosis of acute appendicitis in adults

Abstract

Background Acute appendicitis (AA) is the most common condition presenting with acute abdomen requiring emergency surgery. Several clinical scores were developed to diagnose AA. Aim This study aimed to compare the diagnostic accuracy of three clinical scores (Alvarado score, appendicitis inflammatory response (AIR) score, and adult appendicitis score (AAS)) in the diagnosis of AA. Methods This prospective study was conducted on 100 adult patients (aged ≥ 18 years) presenting with acute abdomen suspicious of noncomplicated AA. Patients with complicated AA (abscess, mass, or diffuse peritonitis) and patients with uncomplicated AA subjected to nonoperative management (NOM) were excluded from our study. The histopathological results were used as the gold standard for diagnosis of AA to which the three clinical scores results were compared. Results Our study included 100 patients (60 males and 40 females), all of whom, had histopathologically proven AA. Due to this outcome, we could only conclude and compare the sensitivities of the three scores. Alvarado score had the highest overall sensitivity (91% at cut-off value > 4 points), followed by AAS (80% at cut-off value > 10 points), then AIR score (71% at cut-off value > 4 points) however, the difference between Alvarado score and AAS was not statistically significant. In males, the Alvarado score had the highest sensitivity (88.3%), followed by AAS (86.7%), then the AIR score (71.7%) at the same cut-off values however, the difference between the Alvarado score and AAS was also not statistically significant. In females, Alvarado score had the highest sensitivity (95%) followed by AAS and AIR scores (70% for both) with a statistically significant difference. Obesity did not influence the outcome of the three scores. Conclusions Alvarado score and AAS are more sensitive than the AIR score. In relation to sex, Alvarado’s score is the most sensitive in females.