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

Authors

  • Bushra Liaqat Department of General Surgery, National Hospital and Medical Centre, Lahore, Punjab, Pakistan.
  • Prof Dr Mahmood Ayyaz Vice Chancellor, King Edward Medical University, Lahore, Punjab, Pakistan.
  • Zehra Rizvi Department of General Surgery, National Hospital and Medical Centre, Lahore, Punjab, Pakistan.
  • Muhammad Sohail Department of General Surgery, National Hospital and Medical Centre, Lahore, Punjab, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i7.1990

Keywords:

Acute Appendicitis, Appendix Inflammatory Response, Sensitivity

Abstract

Introduction: In resource-constrained environments like Pakistan, scoring systems are essential. When radiography is unavailable or ambiguous, these grading systems can be useful for clinical diagnosis, prompt transfer from primary care institutions, and surgical decision-making. The purpose of the current study was to validate the Alvarado-based appendicitis inflammatory response score in patients having appendicectomies for suspected acute appendicitis. Study design: Cross-sectional (validation) study. Settings: Department of Surgery, National Hospital, Lahore. Methodology: The study comprised 213 patients, aged 18 to 60 years presenting with suspected acute appendicitis undergoing appendectomy. Patients with known malignancies, pregnant women, and those with a sonographic diagnostic of an appendicular mass, abscess, or perforation were excluded. The AIR score was determined following a thorough history, examination, and basic laboratory testing. The Alvarado Score was used to make a clinical diagnosis of suspected cases of acute appendicitis. Results were compared with histopathology report. Results: 94.67% AIR score sensitivity, 79.37% specificity, 91.61% PPV, 86.21% NPV, and 90.14% diagnostic accuracy were used to diagnose acute appendicitis. 94.67% AIR score sensitivity, 79.37% specificity, 91.61% PPV, 86.21% NPV, and 90.14% diagnostic accuracy were used to diagnose acute appendicitis. Conclusion: For the precise diagnosis of acute appendicitis, the appendix inflammatory response score offers higher sensitivity and specificity.

Downloads

Download data is not yet available.

References

1. Krzyzak, M., & Mulrooney, S. (2020). Acute appendicitis review: Background, epidemiology, diagnosis, and treatment. Cureus.

https://doi.org/10.7759/cureus.8562

2. Haider, T., Naveed, A., Amjad, F., Kamran, C. M., & Amjad, T. (2025). Validation of appendicitis inflammatory response (AIR) score and Alvarado score. Biological and Clinical Sciences Research Journal, 6(6), 113-116.

https://doi.org/10.54112/bcsrj.v6i6.1840

3. Dixon, F., & Singh, A. (2023). Acute appendicitis. Surgery (Oxford), 41(7), 418-425.

https://doi.org/10.1016/j.mpsur.2023.02.029

4. Al-Tarakji, M., Zarour, A., Singh, R., & Ghali, M. S. (2022). The role of Alvarado score in predicting acute appendicitis and its severity in correlation to histopathology: A retrospective study in a Qatar population. Cureus, 14(7).

https://doi.org/10.7759/cureus.26902

5. Meena, R., Sharma, A. K., Kalwaniya, D. S., Tolat, A., Tyagi, G., Rohith, V. N., & Gurivelli, P. K. (2023). Evaluation of diagnostic accuracy of Alvarado, appendicitis inflammatory response and adult appendicitis scoring system in diagnosing acute appendicitis: A prospective cohort study. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH.

https://doi.org/10.7860/jcdr/2023/60480.17409

6. Pogorelić, Z., Mihanović, J., Ninčević, S., Lukšić, B., Elezović Baloević, S., & Polašek, O. (2021). Validity of appendicitis inflammatory response score in distinguishing perforated from non-perforated appendicitis in children. Children, 8(4), 309.

https://doi.org/10.3390/children8040309

7. Karki, O., & Hazra, N. (2020). Evaluation of the appendicitis inflammatory response score against Alvarado score in diagnosis of acute appendicitis. Kathmandu University Medical Journal, 18(2), 68-72.

https://doi.org/10.3126/kumj.v18i2.33261

8. Tariq, T., Siddiqui, H. R., Khan, I. A., Tasneem, A., & Majeed, S. (2022). Comparison of diagnostic accuracy of appendicitis inflammatory response score and Alvarado score in diagnosis of acute appendicitis taking histopathology as gold standard. Pakistan Journal of Medical and Health Sciences, 16(3), 723-725.

https://doi.org/10.53350/pjmhs22163723

9. Chisthi, M. M., Surendran, A., & Narayanan, J. T. (2020). RIPASA and air scoring systems are superior to alvarado scoring in acute appendicitis: Diagnostic accuracy study. Annals of Medicine and Surgery, 59, 138-142.

https://doi.org/10.1016/j.amsu.2020.09.029

10. Mumtaz, H., Sree, G. S., Vakkalagadda, N. P., Anne, K. K., Jabeen, S., Mehmood, Q., Mehdi, Z., Sohail, H., Haseeb, A., Zafar, Y., Saghir, S., & Hasan, M. (2022). The RIPASA scoring system: A new era in appendicitis diagnosis. Annals of Medicine & Surgery, 80.

https://doi.org/10.1016/j.amsu.2022.104174

11. El Hattabi, K., Bouali, M., El Berni, Y., Bensardi, F., El Bakouri, A., Moufakkir, A., Riad, N., & Fadil, A. (2022). Value of Alvarado scoring system in diagnosis of acute appendicitis. Annals of Medicine & Surgery, 77.

https://doi.org/10.1016/j.amsu.2022.103642

12. Scheijmans, J. C. G., Bom, W. J., Ghori, U. H., van Geloven, A. A. W., Hannink, G., van Rossem, C. C., van de Wouw, L., Huisman, P. M., van Hemert, A., Franken, R. J., Oosterling, S. J., Rosman, C., Koens, L., Stoker, J., Dijkgraaf, M. G. W., Boermeester, M. A., Alberts, F., Bachiri, S., den Bakker, M., & Bisschops, B. (2024). Development and Validation of the Scoring System of Appendicitis Severity 2.0. JAMA Surgery, 159(6), 642.

https://doi.org/10.1001/jamasurg.2024.0235

13. Kinesya, E., Cintya, E. P., Dorothy, M. J., Ennaidi, N. N., Rusti, H. F., Mannagalli, Y., & Pasaribu, E. A. (2022). Diagnostic accuracy of Alvarado score components in patients with appendicitis: Systematic review and meta-analysis approach. Health Sciences Review, 2, 100018.

https://doi.org/10.1016/j.hsr.2022.100018

14. Andersson, R. E., & Stark, J. (2025). Diagnostic value of the appendicitis inflammatory response (AIR) score. A systematic review and meta-analysis. World Journal of Emergency Surgery, 20(1).

https://doi.org/10.1186/s13017-025-00582-x

15. Meier, J., Stevens, A., Bhat, A., Berger, M., & Balentine, C. (2023). Outcomes of nonoperative vs operative management of acute appendicitis in older adults in the US. JAMA Surgery, 158(6), 625.

https://doi.org/10.1001/jamasurg.2023.0284

16. Zeb, M., Khattak, S. K., Samad, M., Shah, S. S., Shah, S. Q., & Haseeb, A. (2023). Comparison of Alvarado score, appendicitis inflammatory response score (AIR) and Raja Isteri Pengiran Anak Saleha appendicitis (RIPASA) score in predicting acute appendicitis. Heliyon, 9(1), e13013.

https://doi.org/10.1016/j.heliyon.2023.e13013

17. Hassan, M., Jeilani, M., Saad, A. A., Iqbal, S., & Boshnaq, M. (2022). Evaluation of Alvarado score and appendicitis inflammatory response score as diagnostic tools for acute appendicitis. International Surgery Journal, 9(12), 1937.

https://doi.org/10.18203/2349-2902.isj20223152

18. Safaee, M., Eshraghi Samani, R., Talebzadeh, H., & Moeini Sam, M. S. (2024). Evaluation and comparison of the results of the Alvarado scoring system with acute inflammatory response score in the diagnosis of acute appendicitis based on the pathological evidence. Immunopathologia Persa, 10(2), e40606.

https://doi.org/10.34172/ipp.2024.40606

19. Poillucci, G., Podda, M., Oricchio, D., Medina, K. L., Manetti, G., & Angelis, R. D. (2022). Comparison between AIR, Alvarado and RIPASA scores in the diagnosis of acute appendicitis in a Western population. A retrospective cohort study. PubMed, 93(4), 427–434.

20. Paracha, S. A., Khattak, I. A., Mabood, W., & Afridi, M. K. K. (2022). Diagnostic Accuracy of Alvarado and Appendicitis Inflammatory Response Score in the Diagnosis of Acute Appendicitis. Medical Forum Monthly, 33(8), 44–48.

https://medicalforummonthly.com/index.php/mfm/article/view/998

Downloads

Published

2025-07-15

How to Cite

Liaqat, B., Ayyaz, P. D. M., Rizvi, Z., & Sohail, M. (2025). Appendicitis Inflammatory Response Score in Comparison to Alvarado Score in Acute Appendicitis. Indus Journal of Bioscience Research, 3(7), 549-552. https://doi.org/10.70749/ijbr.v3i7.1990