TITLE

The Appendicitis Inflammatory Response Score: A Tool for the Diagnosis of Acute Appendicitis that Outperforms the Alvarado Score

AUTHOR(S)
Andersson, Manne; Andersson, Roland E.
PUB. DATE
August 2008
SOURCE
World Journal of Surgery;Aug2008, Vol. 32 Issue 8, p1843
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
The clinical diagnosis of appendicitis is a subjective synthesis of information from variables with ill-defined diagnostic value. This process could be improved by using a scoring system that includes objective variables that reflect the inflammatory response. This study describes the construction and evaluation of a new clinical appendicitis score. Data were collected prospectively from 545 patients admitted for suspected appendicitis at four hospitals. The score was constructed from eight variables with independent diagnostic value (right-lower-quadrant pain, rebound tenderness, muscular defense, WBC count, proportion neutrophils, CRP, body temperature, and vomiting) in 316 randomly selected patients and evaluated on the remaining 229 patients. Ordered logistic regression was used to obtain a high discriminating power with focus on advanced appendicitis. Diagnostic performance was compared with the Alvarado score. The ROC area of the new score was 0.97 for advanced appendicitis and 0.93 for all appendicitis compared with 0.92 ( p = 0.0027) and 0.88 ( p = 0.0007), respectively, for the Alvarado score. Sixty-three percent of the patients were classified into the low- or high-probability group with an accuracy of 97.2%, leaving 37% for further investigation. Seventy-three percent of the nonappendicitis patients, 67% of the advanced appendicitis, and 37% of all appendicitis patients were correctly classified into the low- and high-probability zone, respectively. This simple clinical score can correctly classify the majority of patients with suspected appendicitis, leaving the need for diagnostic imaging or diagnostic laparoscopy to the smaller group of patients with an indeterminate scoring result.
ACCESSION #
33372896

 

Related Articles

  • A rare presentation of Rapunzel syndrome manifesting in the immediate post-appendicectomy period. Nair, Manojkumar S.; Nair, Balachandran M. // Internet Journal of Surgery;2008, Vol. 14 Issue 2, p13 

    To the best of our knowledge this is the first case report in literature where an extensive trichobezoar presented as intestinal obstruction in the immediate appendicectomy period. Rapunzel syndrome is a rare presentation of a trichobezoar, with 27 cases having been reported in literature so...

  • Evaluation of negative appendicectomy rate in cases of suspected acute appendicitis and to study the usefulness of ultrasonography in improving the diagnostic accuracy. Sharma, Rajeev; Kasliwal, Dev K.; Sharma, Raj G. // Indian Journal of Surgery;Oct2007, Vol. 69 Issue 5, p194 

    Acute appendicitis poses a significant diagnostic challenge to the surgeon. Despite modern advances, the diagnosis of appendicitis remains essentially clinical. Ultrasonography is effective in supplementing the clinical diagnosis. This study aims to evaluate the negative appendicectomy rate in...

  • Do Basic Laboratory Tests Add Value in Predicting the Severity of Appendicitis in an Adult Patient Population and Does It Make a Difference in How Severity Is Defined? Kelley, Scott R.; Engel, Amy M.; Hatton, E. Kenneth; Knudson, Josh J.; Clark, Brian J.; Doepker, Matthew P.; Guenther, J. Michael // American Surgeon;Mar2012, Vol. 78 Issue 3, pE175 

    The article focuses on a study which examined whether basic laboratory testing could assist in predicting the severity of appendicitis. The study included 786 adults, aged 18 years old or older, with a histopathologic diagnosis of acute appendicitis between January 1, 2001 and December 31, 2008....

  • Markers of Severe Appendicitis. Tehrani, Hassan Y.; Petros, James G.; Kumar, R. Ravi; Chu, Quyen // American Surgeon;May1999, Vol. 65 Issue 5, p453 

    Provides a study that identified several prognostic markers in the presentation of acute appendicitis. Methodology; Factors responsible for the increasing rate of gangrene and perforation; Diagnosis of the disease.

  • A simple MRI protocol in patients with clinically suspected appendicitis: results in 138 patients and effect on outcome of appendectomy. Cobben, Lodewijk; Groot, Ingrid; Kingma, Lucas; Coerkamp, Emile; Puylaert, Julien; Blickman, Johan // European Radiology;May2009, Vol. 19 Issue 5, p1175 

    To establish the value of breathhold magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis. Over a 14-month period, 138 patients clinically suspected of having appendicitis were evaluated prospectively with MRI and comprised the study group. Fast turbo spin-echo breathhold T1,...

  • Acute myelogenous leukemia and acute leukemic appendicitis: A case report. Po-Jen Hsiao; Shih-Ming Kuo; Jia-Hong Chen; Hsuen-Fu Lin; Pau-Ling Chu; Shih-Hua Lin; Ching-Liang Ho; Møller, Morten Hylander // World Journal of Gastroenterology;11/28/2009, Vol. 15 Issue 44, p5624 

    Acute myelogenous leukemia (AML) can involve the gastrointestinal tract but rarely involves the appendix. We report a male patient who had 1 year partial remission from AML and who presented with apparent acute appendicitis as the initial manifestation of leukemia relapse. Pathological findings...

  • Epiploic Appendagitis: Report of Two Cases. Rupjyoti Talukdar; Nripen Saikia; Subhasish Mazumder; Chandresh Gupta; Sudeep Khanna; Deb Chaudhuri; S.S. Bhullar; Arun Kumar // Surgery Today;Feb2007, Vol. 37 Issue 2, p150 

    Abstract??Epiploic appendagitis (EA) refers to primary or secondary inflammatory disease of the epiploic appendages: peritoneal pouches of subserosal fat, which run in parallel rows beside the taenia coli of the colon. It is an uncommon but self-limiting condition, which often mimics acute...

  • Evaluation of the Appendicitis Inflammatory Response Score for Patients with Acute Appendicitis. Andersson, Roland // World Journal of Surgery;Jul2012, Vol. 36 Issue 7, p1546 

    The author discusses the validation study on appendicitis inflammatory response (AIR) score in the management of patients with acute appendicitis (AA). He states that the role of diagnostic techniques and clinical diagnosis was also examined. He mentions that the study used an algorithm based on...

  • Use and Accuracy of Computed Tomography Scan in Diagnosing Perforated Appendicitis. VERMA, RICHA; GRECHUSHKIN, VADIM; CARTER, DOROTHY; BARISH, MATTHEW; PRYOR, AURORA; TELEM, DANA // American Surgeon;Apr2015, Vol. 81 Issue 4, p404 

    Perforated appendicitis has major implications on patient care. The ability of computed tomography (CT) scan to distinguish perforation in the absence of phlegmon or abscess is unknown. The purpose of this study is to assess the use and accuracy of CT scans in diagnosing perforated appendicitis...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics