Alvarado Score Still Holds: A Prospective Comparison of Modified Alvarado Score [MAS] and Appendicitis Inflammatory Response Score [AIRS] as a Diagnostic Aid in Acute Appendicitis

  • Dr Varun Kumar Singh Assistant Professor, Department of Surgery, Sikkim Manipal Institute of Medical Sciences, Gangtok, India
  • Dr Bikram Kharga Associate Professor, Department of Surgery, Sikkim Manipal Institute of Medical Sciences, Gangtok, India
  • Dr Kumar Nishant Associate Professor, Department of Surgery, Sikkim Manipal Institute of Medical Sciences, Gangtok, India
  • Dr Phuchungla Bhutia Assistant Professor, Department of Surgery, Sikkim Manipal Institute of Medical Sciences, Gangtok, India
  • Dr Barun Kumar Sharma Associate Professor, Department of Radiodiagnosis, Sikkim Manipal Institute of Medical Sciences, Gangtok, India
  • Dr Neha Pandey MBBS Undergraduate Student, Sikkim Manipal Institute of Medical Sciences, Gangtok, India
DOI: https://doi.org/10.17511/ijoso.2016.i03.01
Keywords: AIRS, Alvarado, Appendicitis, Appendectomy, MAS

Abstract

Introduction: In pre-imaging era, diagnosis of appendicitis was based on clinical assessment. To decrease chances of error and negative appendectomy, Alvarado was first to propose a score in 1885. A number of scores were then put forward including modification of Alvarado score. This study aimed to compare two most commonly used systems, MAS and AIRS.

Methods: On admission MAS and AIRS were compared in patients of right iliac fossa pain who subsequently underwent appendectomy. Histopathologic examination was taken as gold standard outcome and MAS and AIRS as tests under evaluation.

Results: Study analysed 229 patients with a mean age of 32.69 years and male to female ratio of 1.04. Female patients were older than male patients [35.25 and 30.14 years, respectively; p=0.017]. Negative appendectomy rate was just under 4%. Sensitivity, specificity, PPV and NPV of MAS were 85%, 44.4%, 97.4% and 10.8% and for AIRS were 81.8%, 11.1%, 95.7% and 2.4%. Sensitivity in children and adolescents was 90% and 72.5% for MAS and AIRS, respectively. There was no gender difference between the two. AUC for ROC curve of MAS and AIRS was 0.669 [0.474-0.863] and 0.481 [0.285-0.677] with a significant difference [p=0.0003].

Conclusion: Both scores are sensitive, underdiagnose patients as low risk, but don’t leave any patient with advanced appendicitis. MAS outperforms AIRS for all cases of appendicitis as well as advanced appendicitis. Since both scores classify a large number of patients as low risk, before deciding a surgical intervention, an imaging aid should always be welcome.

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Alvarado Score Still Holds: A Prospective Comparison of Modified Alvarado Score [MAS] and Appendicitis Inflammatory Response Score [AIRS] as a Diagnostic Aid in Acute Appendicitis
CITATION
DOI: 10.17511/ijoso.2016.i03.01
Published: 2016-09-30
How to Cite
Kumar Singh, V., Kharga, B., Nishant, K., Bhutia, P., Kumar Sharma, B., & Pandey, N. (2016). Alvarado Score Still Holds: A Prospective Comparison of Modified Alvarado Score [MAS] and Appendicitis Inflammatory Response Score [AIRS] as a Diagnostic Aid in Acute Appendicitis. Surgical Review: International Journal of Surgery, Trauma and Orthopedics, 2(3), 21-29. https://doi.org/10.17511/ijoso.2016.i03.01
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Vol 2 No 3 (2016): Jul-Sep
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Original Article

Copyright (c) 2016 Author (s). Published by Siddharth Health Research and Social Welfare Society

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