Can Alvarado and Appendicitis Inflammatory Response scores evaluate the severity of acute appendicitis?

BACKGROUND: The Alvarado score (AS) and the Appendicitis Inflammatory Response score (AIRS) were developed to diagnose acute appendicitis (AA). The aim of this study was to evaluate the severity of AA using the AS and the AIRS tools.

METHODS: Patients who presented between January 2016 and December 2017 and underwent surgery for AA and who had a preoperative AS and AIRS value were evaluated retrospectively. The details of age, sex, pathological severity, the presence of local peritonitis or fecaloid, drainage, appendix diameter, and operation type were evaluated according to the AS and the AIRS.

RESULTS: A total of 578 patients were included in the study. Appendicitis was the most common pathological severity classification (44.4%). The most common appendix diameter group was 7-10 mm (59.2%). The difference observed in the AS and AIRS results for all of the pathological severity categories was statistically significant (p<0.05). The AIRS revealed a statistically significant difference (p<0.05) in the detection of uncomplicated and complicated appendicitis. The AIRS difference was statistically significant for appendix diameter (p<0.05). The AS and the AIRS results were both statistically significant for drainage (p<0.05). The AS was correlated with pathological severity, local peritonitis, and drainage, while the AIRS was correlated with pathological severity, uncomplicated/complicated determination, appendix diameter, and drainage (p<0.05).

CONCLUSION: Both the AS and the AIRS can evaluate pathological severity, but only the AIRS can evaluate complicated or uncomplicated appendicitis and the diameter of the appendix. These tools can be used to reduce the number of unnecessary radiological or surgical interventions.