APPLICATION OF APPENDICITIS INFLAMMATORY RESPONSE (AIR) SCORING SYSTEM FOR DIAGNOSIS OF ACUTE APPENDICITIS AND ITS COMPARISON WITH ALVARADO SCORE

Background: The appendicitis inflammatory response (AIR) score is recently developed diagnostic tool that uses seven scored variables to stratify patients into low-, intermediate and high risk group. Methods: The present study was conducted in the department of surgery. The popultion consists of 100 patients presenting with pain in the right lower quadrant of abdomen, who after clinical examination were provisionally diagnosed to have acute appendicitis and warranted surgery for the same. Results: AIR (98.91%) were more sensitive than Modified alverdo score (89.3%). Specificity (100%) and positive predict value (100%) were same in MAS & AIR Conclusion- To conclude, AIR scoring performed well almost equally with Alvarado system with high specificity and high negative predictive value preventing unnecessary negative appendectomies. Keywords: AIR, MAS, Acute appendicitis

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APPLICATION OF APPENDICITIS INFLAMMATORY RESPONSE (AIR) SCORING SYSTEM FOR DIAGNOSIS OF ACUTE APPENDICITIS AND ITS COMPARISON WITH ALVARADO SCORE

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i2.1736 ◽

2021 ◽

Vol 5 (2) ◽

Author(s):

Ghaus Mohd Chouhan ◽

Mahesh Kumar Sharma

Keyword(s):

Inflammatory Response ◽

Acute Appendicitis ◽

High Specificity ◽

High Risk Group ◽

Alvarado Score ◽

Lower Quadrant ◽

Positive Predict Value ◽

High Negative Predictive Value ◽

The Right ◽

Right Lower Quadrant

Background: The appendicitis inflammatory response (AIR) score is recently developed diagnostic tool that uses seven scored variables to stratify patients into low-, intermediate and high risk group. Methods: The present study was conducted in the department of surgery. 100 patients presenting with pain in the right lower quadrant of abdomen, who after clinical examination were provisionally diagnosed to have acute appendicitis and warranted surgery for the same. Results: AIR (98.00%) were more sensitive than Modified alverdo score (90.00%). Specificity (100%) and positive predict value (100%) were same in MAS & AIR. Conclusion: To conclude, AIR scoring performed well almost equally with Alvarado system with high specificity and high negative predictive value preventing unnecessary negative appendectomies. Keywords: AIR, MAS, Acute appendicitis

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The use of ultrasonographic and Alvarado scores in evaluating abdominal pain suggestive of acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20170228 ◽

2017 ◽

Vol 4 (2) ◽

pp. 757 ◽

Cited By ~ 1

Author(s):

Jorge Fernández Álvarez ◽

José Manuel Gómez López ◽

Alberto M González Chávez ◽

Benjamín Valente Acosta ◽

Diego Abelardo Álvarez Hénandez ◽

...

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Sensitivity And Specificity ◽

Area Under The Curve ◽

Alvarado Score ◽

Lower Quadrant ◽

Efficient Alternative ◽

Two Parameters ◽

The Right ◽

Right Lower Quadrant

Background: Ultrasonographic scores for appendicitis to determine if, combined with Alvarado scores, they can increase the sensitivity and specificity of the diagnosis of appendicitis.Methods: All cases of abdominal pain suggestive of appendicitis presented between 2013 and 2015 were analysed. An Alvarado score was obtained. All patients underwent ultrasound, and an ultrasonographic score was determined, including the appendicitis classical findings.Results: Two hundred and fifty-one patients with abdominal pain in the right lower quadrant were analysed. Appendicitis was confirmed in 211 (84%) patients. For these patients, the average Alvarado score was 7.95/10 (±1.25) vs. 5.7/10 (± 1.11) for patients who did not have appendicitis (p < 0.001). In patients with confirmed appendicitis, the average ultrasonographic score was 2.48/6 (± 1.06) vs. 0.6/6 (± 0.92) for patients who did not have acute appendicitis (p < 0.001). The ultrasonographic score has a sensitivity of 90% and a specificity of 87% with only two parameters. The combination of the Alvarado and ultrasonographic scores decreased the percentage of negative appendectomies to 2.36% and increased the area under the curve by 0.970.Conclusions: The sum of the Alvarado and ultrasonographic scores provides an efficient alternative for diagnosing abdominal pain suggestive of appendicitis and predicts which patients should undergo surgery with good certainty.

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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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Appendicitis: a rare adverse event in colonoscopy

BMJ Case Reports ◽

10.1136/bcr-2021-242523 ◽

2021 ◽

Vol 14 (7) ◽

pp. e242523

Author(s):

Samer Al-Dury ◽

Mohammad Khalil ◽

Riadh Sadik ◽

Per Hedenström

Keyword(s):

Emergency Department ◽

Adverse Event ◽

Abdominal Pain ◽

Acute Appendicitis ◽

Physical Examination ◽

De Novo ◽

Perforated Appendicitis ◽

Lower Quadrant ◽

The Right ◽

Right Lower Quadrant

We present a case of a 41-year-old woman who visited the emergency department (ED) with acute abdomen. She was diagnosed with perforated appendicitis and abscess formation on CT. She was treated conservatively with antibiotics and discharged. On control CT 3 months later, the appendix had healed, but signs of thickening of the terminal ileum were noticed and colonoscopy was performed, which was uneventful and showed no signs of inflammation. Twelve hours later, she developed pain in the right lower quadrant, followed by fever, and visited the ED. Physical examination and blood work showed signs consistent with acute appendicitis, and appendectomy was performed laparoscopically 6 hours later. The patient recovered remarkably shortly afterwards. Whether colonoscopy resulted in de novo appendicitis or exacerbated an already existing inflammation remains unknown. However, endoscopists should be aware of this rare, yet serious complication and consider it in the workup of post-colonoscopy abdominal pain.

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Predictive value of scoring systems for the diagnosis of acute appendicitis in emergency department patients: Is there an accurate one?

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907919840175 ◽

2019 ◽

Vol 27 (5) ◽

pp. 262-269

Author(s):

Rohat Ak ◽

Fatih Doğanay ◽

Ebru Unal Akoğlu ◽

Haldun Akoğlu ◽

Aslı Bahar Uçar ◽

...

Keyword(s):

Inflammatory Response ◽

Acute Appendicitis ◽

Area Under The Curve ◽

Scoring Systems ◽

Acute Inflammatory Response ◽

Quadrant Pain ◽

Lower Quadrant Pain ◽

Lower Quadrant ◽

Right Lower Quadrant Pain ◽

Right Lower Quadrant

Background: Acute appendicitis is one of the challenging surgical conditions presented in the emergency departments. Clinical scoring systems were developed to reduce the negative appendectomy rate and also to avoid unnecessary diagnostic evaluation. Objectives: The primary aim was to compare the clinical adequacy of the Alvarado, Acute Inflammatory Response, and the Raja Isteri Pengiran Anak Saleha Appendicitis scores in patients with right lower quadrant pain for the diagnosis of acute appendicitis. Methods: This was a prospective and observational study. All patients over the age of 18 years who presented with a complaint of right lower quadrant pain were enrolled. The Alvarado, Acute Inflammatory Response, and Raja Isteri Pengiran Anak Saleha Appendicitis scoring systems were compared. The patients were either admitted or followed-up as out-patient. Face-to-face or telephone follow-up visits were arranged for the patients who did not have surgery and who were not admitted. Results: 232 patients were included and 14 patients were excluded from the study. Of the 218 patients, 114 patients underwent surgery. Of the 114 patients, 107 patients were pathologically diagnosed with acute appendicitis. It was determined that Raja Isteri Pengiran Anak Saleha Appendicitis score was the most valuable score with 0.88 accuracy, followed by Acute Inflammatory Response (area under the curve = 0.79) and Alvarado (area under the curve = 0.71) scores. Conclusion: The accuracy of Raja Isteri Pengiran Anak Saleha Appendicitis scoring system was higher for the diagnosis of acute appendicitis than the other scores. The cut-off of the Raja Isteri Pengiran Anak Saleha Appendicitis score from a 7.5-point threshold provides a practical, non-invasive, rapid diagnostic method that increases acute appendicitis discriminative power in patients presenting with right lower quadrant pain.

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Appendiceal Endometriosis: A Rare Cause of Acute Appendicitis

Journal of Surgical Case Reports and Images ◽

10.31579/2690-1897/040 ◽

2020 ◽

Vol 3 (5) ◽

pp. 01-03

Author(s):

Georgios Koimtzis

Keyword(s):

Acute Appendicitis ◽

Diagnostic Laparoscopy ◽

Reproductive Organs ◽

Lymphoid Hyperplasia ◽

Reproductive Age ◽

Histologic Examination ◽

Diagnostic Process ◽

Lower Quadrant ◽

The Right ◽

Right Lower Quadrant

Background: Acute appendicitis is the most common cause of acute abdomen. The etiology has not been defined clearly but potential causes are fecoliths, lymphoid hyperplasia and malignancies. However, an extremely uncommon cause of acute appendicitis is endometriosis which leads to dilemmas in the diagnostic process. Case report: A 21-year-old Caucasian female patient presented in the Emergency department complaining of acute progressive abdominal pain in the right lower quadrant. The physical examination revealed signs consistent with acute appendicitis. The patient underwent diagnostic laparoscopy, which revealed early inflammation of the appendix and thus was subjected to appendicectomy. Histologic examination revealed endometriosis of the appendix. Conclusion: The presented case emphasizes on how endometriosis can affect only the appendix without any involvement of the reproductive organs. A high index of clinical suspicion is required especially in women of reproductive age who present with periodic chronic pain associated with their menstrual cycle. Nonetheless, this can only be confirmed through diagnostic laparoscopy and histologic examination, which also provides the definite cure of the disease.

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The Utility of the Alvarado Score in the Diagnosis of Acute Appendicitis in the Elderly

The American Surgeon ◽

10.1177/000313481708300740 ◽

2017 ◽

Vol 83 (7) ◽

pp. 793-798 ◽

Cited By ~ 4

Author(s):

Anastasiya Shchatsko ◽

Rebecca Brown ◽

Trista Reid ◽

Sasha Adams ◽

Amy Alger ◽

...

Keyword(s):

Acute Appendicitis ◽

Elderly Patients ◽

Chart Review ◽

Retrospective Chart Review ◽

The Elderly ◽

Inclusion Criteria ◽

Alvarado Score ◽

Lower Quadrant ◽

Left Shift ◽

Right Lower Quadrant

Clinical scores determining the likelihood of acute appendicitis (AA), including the Alvarado score, were devised using a younger population, and their efficacy in predicting AA in elderly patients is not well documented. This study's purpose is to evaluate the utility of Alvarado scores in this population. A retrospective chart review of patients >65 years old presenting with pathologically diagnosed AA from 2000 to 2010 was performed. Ninety-six patients met inclusion criteria. The average age was 73.7 ± 1.5 years and our cohort was 41.7 per cent male. The average Alvarado score was 6.9 ± 0.33. The distribution of scores was 1 to 4 in 3.7 per cent, 5 to 6 in 37.8 per cent, and 7 to 10 in 58.5 per cent of cases. There was a statistically significant increase in patients scoring 5 or 6 in our cohort versus the original Alvarado cohort (P < 0.01). Right lower quadrant tenderness (97.6%), left shift of neutrophils (91.5%), and leukocytosis (84.1%) were the most common symptoms on presentation. In conclusion, our data suggest that altering our interpretation of the Alvarado score to classify elderly patients presenting with a score of ≥5 as high risk may lead to earlier diagnosis of AA. Physicians should have a higher clinical suspicion of AA in elderly patients presenting with right lower quadrant tenderness, left shift, or leukocytosis.

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Manifestations of Pediatric Appendicopathia Oxyurica

The American Surgeon ◽

10.1177/000313481307900918 ◽

2013 ◽

Vol 79 (9) ◽

pp. 873-874 ◽

Cited By ~ 1

Author(s):

Mary M. Jordan ◽

Jennifer E. Sanders ◽

Christina R. Stallworth ◽

Scott Russell ◽

Olivia Titus ◽

...

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Ex Vivo ◽

Low Grade ◽

Enterobius Vermicularis ◽

Lower Quadrant ◽

First Case ◽

Human Digestive Tract ◽

The Right ◽

Right Lower Quadrant

Enterobius vermicularis is a parasite that inhabits the human digestive tract. We present two pediatric patients with symptoms mimicking acute appendicitis who were found to have E. vermicularis infection. The first case is a 5-year-old female who presented with flank and abdominal pain associated with low-grade fever and anorexia. She had localized tenderness in the right lower quadrant and a leukocytosis with left shift. Intraoperative findings included a normal-appearing appendix, but ex vivo examination revealed Enterobius vermicularis. The second case is a 7-year-old female who presented with periumbilical abdominal pain, anorexia, and emesis. She had tenderness at McBurney's point, and ultrasound revealed a small echogenic focus within the appendix. Intraoperatively, the distal tip of the appendix appeared inflamed. Again, ex vivo examination revealed E. vermicularis. Enterobius vermicularis infection of the appendix can present with a clinical picture similar to acute appendicitis. In at-risk populations, it should be included in the differential diagnosis for children with right lower quadrant abdominal pain. Complete therapy requires treatment with mebendazole.

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Alvarado score in the diagnostic of pain in the right lower quadrant

Revista de la Facultad de Ciencias Médicas de Córdoba ◽

10.31053/1853.0605.v74.n3.14568 ◽

2017 ◽

Vol 74 (3) ◽

pp. 214 ◽

Cited By ~ 1

Author(s):

Paul Eduardo Lada

Keyword(s):

Font Size ◽

Alvarado Score ◽

Lower Quadrant ◽

The Right ◽

Right Lower Quadrant

RESUMENAntecedentes: La apendicitis aguda no sospechada y diagnosticada puede evolucionar hacia la perforación, ó por el contrario conduce a la remoción de un apéndice normal. Objetivo: La utilización de un sistema de Score, desde un punto de vista clínico, para el diagnóstico de esta patología y lograr disminuir las apendicetomías negativas.Lugar de Aplicación: Hospital Nacional de Clínicas. Córdoba. (Argentina)Diseño: Estudio prospectivo y protocolizado.Material y Métodos: Comprende a 594 pacientes estudiados entre octubre de 2002 y diciembre del 2013. De ellos, 312 eran del sexo masculino y 282 del femenino, con una edad promedio de 26,2 años de edad. A todos los pacientes se les realizo al ingreso el Score de Alvarado. En base a la clínica y a una segunda valoración con el Score se decidió la exploración quirúrgica en 574 pacientes. De los 20 restantes, fueron excluidos por otra patología. El diagnóstico de apendicitis aguda fue confirmado por los hallazgos quirúrgicos y la anatomía patológica.Resultados: En los hallazgos operatorios se encontró en 524 pacientes (91,28%) que tenían una apendicitis aguda. No hubo mortalidad postoperatoria. En relación a la morbilidad hubo un 1,74 % de complicaciones médicas y un 13,93 % de las quirúrgicas. El informe anatomopatológico mostró en 50 pacientes un apéndice cecal normal. Por lo tanto la incidencia de las apendicetomías negativas fue del 8,71%. Conclusiones: La utilización del Score en relación a los hallazgos quirúrgicos y anatomopatológicos confirma que fue sensible a partir de 6 puntos para el diagnóstico de apendicitis aguda.

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