COMPARATIVE ANALYSIS OF THE DIAGNOSTIC ACCURACY OF THE APPENDICITIS INFLAMMATORY RESPONSE SCORE AND THE ALVARADO SCORE IN ACUTE APPENDICITIS USING HISTOPATHOLOGY AS THE GOLD STANDARD

Abstract

Background: Appendicitis is difficult to diagnose, especially in children, the elderly, and reproductive-aged females, because symptoms overlap with those of other conditions. The Alvarado and Appendicitis Inflammatory Response scores have been developed as clinical scoring systems to aid diagnosis. Nevertheless, they have merits and demerits, which need to be researched further in terms of comparative accuracy.

Objectives: To compare the diagnostic accuracy of the Alvarado Score and the Appendicitis Inflammatory Response (AIR) Score in patients presenting with suspected acute appendicitis, using histopathological findings as the gold standard.

Methods: It was Comparative cross-sectional validation study. The study was conducted at Surgical Unit III, Allama Iqbal Memorial Teaching Hospital, Sialkot, from November 20, 2024, to May 20, 2025. A total of 205 patients aged 18–70 years presenting with clinical signs of acute appendicitis were included using non-probability consecutive sampling. Each patient’s Alvarado and AIR scores were calculated based on clinical, laboratory, and radiological findings. All patients underwent appendectomy, and the removed specimens were examined histopathologically. Diagnostic performance was evaluated by calculating sensitivity, specificity, positive and negative predictive value (PPV, NPV), positive and negative likelihood ratio, and overall accuracy using SPSS ver. 26.0.

Results: Among patients (63.4% male, mean age 28.04 ± 4.17 years), histopathology confirmed acute appendicitis in 161 (78.5%). The Alvarado Score showed 92.55% sensitivity, 97.73% specificity, and 93.66% accuracy, while the AIR Score had 88.20% sensitivity, 97.73% specificity, and 90.24% accuracy.

Conclusion: The Alvarado and AIR Scores are reliable for diagnosing acute appendicitis, with the Alvarado Score slightly outperforming in sensitivity and accuracy. The Alvarado Score may be preferred in emergency settings for efficient diagnosis and management.