Appendicitis Inflammatory Response Score in Comparison to Alvarado Score in Acute Appendicitis

AbstractAppendicitis is a common differential diagnosis of right lower quadrant pain. Clinical evaluation alone results in high negative appendicectomy rates. Alvarado scoring is the most commonly used clinical prediction rule. The study aimed to compare the recently developed appendicitis inflammatory response (AIR) score with the Alvarado score. This cross-sectional observational study included patients who underwent appendicectomy for clinical suspicion of appendicitis. The clinical and laboratory parameters required for obtaining Alvarado score and AIRS were gathered. Area under ROC curve was calculated for both Alvarado score and AIRS. The study included 130 patients (77 males and 53 females). The negative appendicectomy rate was 10.7%. The perforation rate was 10.3%. The area under ROC for Alvarado score was 0.821 and for AIR score was 0.901. The Alvarado score had a sensitivity of 72% and a specificity of 79% at score ≥6. The appendicitis inflammatory response score had a sensitivity of 98% for scores ≥5 and a specificity of 97% for score ≥6. The C-reactive protein (CRP) value was the best performing individual parameter with an area under ROC of 0.789, followed by WBC count with an area under ROC of 0.762. Appendicitis inflammatory response score is a recently developed score that outperforms the Alvarado score. AIR score has a higher specificity. The sound construction, gradation of parameters, the inclusion of CRP, and avoidance of subjective parameters make the AIR score an attractive clinical prediction rule which can decrease the rate of negative appendicectomy.

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Validation of the appendicitis inflammatory response score in a provincial population

International Surgery Journal ◽

10.18203/2349-2902.isj20204655 ◽

2020 ◽

Vol 7 (11) ◽

pp. 3540

Author(s):

Paul V. B. Fagan ◽

Brad Stanfield ◽

Olga Korduke ◽

Nigel Henderson ◽

Karl Kodeda

Keyword(s):

Inflammatory Response ◽

Characteristic Curve ◽

Clinical Prediction ◽

Alvarado Score ◽

High Performing ◽

Single Centre Study ◽

Negative Appendicectomy ◽

Histological Results ◽

Clinical Prediction Tool ◽

Response Score

Background: The appendicitis inflammatory response (AIR) score is a high performing, and easy to use clinical prediction tool for the evaluation of appendicitis, but its efficacy has not been studied in the provincial setting. This retrospective, single centre study aims to validate the AIR score, estimate the effect AIR score-based risk stratification would have on the negative appendicectomy rate and compare it against other well-known clinical prediction tools for appendicitis.Methods: 425 patients treated with appendicectomy or laparoscopy between 1st Jan 2015 and Dec 31st 2017 were retrospectively provided with an AIR score. This score was compared against the final macroscopic and histological results to determine its accuracy in the local population.Results: The AIR score did not perform as well as in other published series, with an area under the receiver operating characteristic curve (AUC) of 0.836. The AIR score performed favourably in comparison to the Alvarado score (0.761), APPEND score (0.747) and adult appendicitis score (AAS) (0.828).Conclusions: This study showed that the AIR score has a high accuracy, and validates its use in a provincial setting. AIR score-based management of appendicitis would be expected to reduce non-therapeutic explorations by a minimum of 50%.

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Appendicitis inflammatory response score: a novel scoring system for acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20170863 ◽

2017 ◽

Vol 4 (3) ◽

pp. 1065

Author(s):

Suresh Patil ◽

Rahul Harwal ◽

Sharanabasappa Harwal ◽

Sangamesh Kamthane

Keyword(s):

Inflammatory Response ◽

Acute Appendicitis ◽

Scoring Systems ◽

Alvarado Score ◽

Lower Quadrant ◽

Negative Laparotomy ◽

Surgical Emergencies ◽

Prospective Comparative Study ◽

The Right ◽

Response Score

Background: Acute appendicitis is one of the most common surgical emergencies encountered by doctors on call with emergency appendicectomy being a very common outcome of emergency laparotomies. There's been a marked decline in mortality over the past 50 years, but the rates of perforation and negative laparotomy have not changed much as they're influenced by factors untouched by technological advances.Methods: A prospective comparative study to compare appendicitis inflammatory response score (AIR) and Alvarado scoring systems in evaluating suspected cases of acute appendicitis. 100 patients presenting with pain in the right lower quadrant of abdomen at the surgical clinics at Basaveshwar Teaching and General Hospital, Kalaburagi, Karnataka, India, who after clinical examination and relevant investigations were provisionally diagnosed to have acute appendicitis and warranted surgery for the same were evaluated using the scoring systems - Alvarado Score and Appendicitis Inflammatory Response Score. The scores were tallied and compared with final histopathology report. The study was conducted for a period of one and a half year.Results: The results revealed that AIR (at score >4) demonstrated a higher sensitivity and specificity compared to Alvarado score (89.9 versus 78.6%) and (63.6 versus 54.5) respectively. Alvarado showed a slightly better sensitivity at score>8 (21.3 versus 12.3%).Conclusions: The Appendicitis Inflammatory Response Score outperformed the Alvarado score. It holds promise to be incorporated into the clinician's daily inventory in efficiently diagnosing Appendicitis.

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Faculty Opinions recommendation of Derivation and validation of a clinical prediction rule for uncomplicated ureteral stone--the STONE score: retrospective and prospective observational cohort studies.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718326320.793493330 ◽

2014 ◽

Author(s):

M Hammad Ather

Keyword(s):

Cohort Studies ◽

Ureteral Stone ◽

Prediction Rule ◽

Clinical Prediction Rule ◽

Clinical Prediction ◽

Observational Cohort

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Inter‐rater reliability and prospective validation of a clinical prediction rule for SARS‐CoV‐2 infection

Academic Emergency Medicine ◽

10.1111/acem.14309 ◽

2021 ◽

Author(s):

Adam E. Nevel ◽

Jeffrey A. Kline

Keyword(s):

Prediction Rule ◽

Clinical Prediction Rule ◽

Clinical Prediction ◽

Rater Reliability

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Development and validation of a clinical prediction rule for development of diabetic foot ulceration: an analysis of data from five cohort studies

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2021-002150 ◽

2021 ◽

Vol 9 (1) ◽

pp. e002150

Author(s):

Francesca M Chappell ◽

Fay Crawford ◽

Margaret Horne ◽

Graham P Leese ◽

Angela Martin ◽

...

Keyword(s):

Cohort Studies ◽

Secondary Care ◽

Prediction Rule ◽

Clinical Prediction Rule ◽

Initial Assessment ◽

Validation Dataset ◽

Benefit Analysis ◽

Clinical Prediction ◽

Net Benefit ◽

Foot Ulceration

IntroductionThe aim of the study was to develop and validate a clinical prediction rule (CPR) for foot ulceration in people with diabetes.Research design and methodsDevelopment of a CPR using individual participant data from four international cohort studies identified by systematic review, with validation in a fifth study. Development cohorts were from primary and secondary care foot clinics in Europe and the USA (n=8255, adults over 18 years old, with diabetes, ulcer free at recruitment). Using data from monofilament testing, presence/absence of pulses, and participant history of previous ulcer and/or amputation, we developed a simple CPR to predict who will develop a foot ulcer within 2 years of initial assessment and validated it in a fifth study (n=3324). The CPR’s performance was assessed with C-statistics, calibration slopes, calibration-in-the-large, and a net benefit analysis.ResultsCPR scores of 0, 1, 2, 3, and 4 had a risk of ulcer within 2 years of 2.4% (95% CI 1.5% to 3.9%), 6.0% (95% CI 3.5% to 9.5%), 14.0% (95% CI 8.5% to 21.3%), 29.2% (95% CI 19.2% to 41.0%), and 51.1% (95% CI 37.9% to 64.1%), respectively. In the validation dataset, calibration-in-the-large was −0.374 (95% CI −0.561 to −0.187) and calibration slope 1.139 (95% CI 0.994 to 1.283). The C-statistic was 0.829 (95% CI 0.790 to 0.868). The net benefit analysis suggested that people with a CPR score of 1 or more (risk of ulceration 6.0% or more) should be referred for treatment.ConclusionThe clinical prediction rule is simple, using routinely obtained data, and could help prevent foot ulcers by redirecting care to patients with scores of 1 or above. It has been validated in a community setting, and requires further validation in secondary care settings.

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Developing a clinical prediction rule for repeated consultations with functional somatic symptoms in primary care: a cohort study

BMJ Open ◽

10.1136/bmjopen-2020-040730 ◽

2021 ◽

Vol 11 (1) ◽

pp. e040730

Author(s):

Gea A Holtman ◽

Huibert Burger ◽

Robert A Verheij ◽

Hans Wouters ◽

Marjolein Y Berger ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Somatic Symptoms ◽

Prediction Rule ◽

Clinical Prediction Rule ◽

Model Discrimination ◽

Clinical Prediction ◽

Internal Validation ◽

Predictive Values ◽

Healthy Activity

ObjectivesPatients who present in primary care with chronic functional somatic symptoms (FSS) have reduced quality of life and increased health care costs. Recognising these early is a challenge. The aim is to develop and internally validate a clinical prediction rule for repeated consultations with FSS.Design and settingRecords from the longitudinal population-based (‘Lifelines’) cohort study were linked to electronic health records from general practitioners (GPs).ParticipantsWe included patients consulting a GP with FSS within 1 year after baseline assessment in the Lifelines cohort.Outcome measuresThe outcome is repeated consultations with FSS, defined as ≥3 extra consultations for FSS within 1 year after the first consultation. Multivariable logistic regression, with bootstrapping for internal validation, was used to develop a risk prediction model from 14 literature-based predictors. Model discrimination, calibration and diagnostic accuracy were assessed.Results18 810 participants were identified by database linkage, of whom 2650 consulted a GP with FSS and 297 (11%) had ≥3 extra consultations. In the final multivariable model, older age, female sex, lack of healthy activity, presence of generalised anxiety disorder and higher number of GP consultations in the last year predicted repeated consultations. Discrimination after internal validation was 0.64 with a calibration slope of 0.95. The positive predictive value of patients with high scores on the model was 0.37 (0.29–0.47).ConclusionsSeveral theoretically suggested predisposing and precipitating predictors, including neuroticism and stressful life events, surprisingly failed to contribute to our final model. Moreover, this model mostly included general predictors of increased risk of repeated consultations among patients with FSS. The model discrimination and positive predictive values were insufficient and preclude clinical implementation.

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