Analysis of Comparative Appendicitis Inflammatory Response Score Versus ALVARADO Score as a Diagnostic Tool for Acute Appendicitis

Abstract

Background: Acute appendicitis remains a prevalent surgical emergency, yet its diagnosis is often complicated by overlapping symptoms and limited access to imaging in resource-constrained settings. Objective: This study aimed to compare the diagnostic accuracy of the AIR score versus the Alvarado score in predicting acute appendicitis, using histopathological findings as the gold standard. Methods: This prospective observational cohort study was conducted at Combined Military Hospital (CMH) Rawalpindi over six months, including 185 patients with clinical suspicion of acute appendicitis who underwent surgery. Patients under 6 years, pregnant, or with abdominal trauma or malignancy were excluded. Alvarado and AIR scores were computed preoperatively, blinded to surgical decision-making. Histopathology confirmed diagnoses. Ethical approval was obtained from the CMH Ethical Review Committee per the Declaration of Helsinki. Data were analyzed using SPSS v27, with diagnostic accuracy, sensitivity, specificity, PPV, and NPV calculated. Results: Of 185 patients (mean age: 28.21 ± 12.76 years), histopathology confirmed appendicitis in 162 (87.6%). The AIR score (cut-off ≥6) demonstrated higher accuracy (89.19%) compared to the Alvarado score (cut-off ≥7, accuracy: 69.73%), with superior sensitivity (90.12% vs. 70.37%), specificity (82.61% vs. 65.22%), PPV (97.33% vs. 93.44%), and NPV (54.29% vs. 23.81%). Conclusion: The AIR score outperformed the Alvarado score in diagnostic precision, offering a more objective and reliable tool for acute appendicitis diagnosis. Its integration into clinical protocols may reduce unnecessary imaging and surgeries, enhancing decision-making in emergency and low-resource settings.