appendicities sujan

1. D. Kolla´r et al
Department of Surgery, Waterford Regional Hospital,
Dunmore Road, Waterford, Republic of Ireland
Published on September 2014
Predicting Acute Appendicitis? A comparison
of the Alvarado Score, the Appendicitis
Inflammatory Response Score and Clinical
Assessment

2. • Acute appendicitis always pose a diagnostic
challenge
• Acute appendicitis inflammatory response
score is new scoring system
• Commonly used Alvarado scoring system have
proven impact in diagnosing appendicitis

3. • Studies have shown superiority of AIRS VS
ALVARADO
De Castro SMM, U¨ nlu¨ C, Steller E et al (2012) Evaluation of the
appendicitis inflammatory response score for patients with acute
appendicitis. World J Surg 36:1540–1545

4. AIM
• Evaluate the AIR score
• Compare with
-Alvarado score
-clinical impression of senior surgeon

5. Hypothesis
AIR score is superior to Alvarado and clinical impression
of experience surgeon

6. Methods
Inclusion criteria
All patients referred to the General Surgical team on call
with acute RIF pain from 1st January to 1st July 2013
Prospective study was done

7. Patient with pain RIR
Resident filled up the score Performa
Senior consultant will do clinical assessment
Radiological assessment/surgery

8. Operation
Histopathology report
AppendicitisNo inflammation Advance appendicitis
Scoring from previous collected perfoma done at the end of
study
Statistical analysis done

9. Statistical analysis
• Minitab statistical software (Minitab Inc, PA,USA).
• Categorical variables were assessed using Fishers exact
test.
• A p value of less than 0.05 was considered significant.
• The diagnostic performances were assessed on
calculated values for sensitivity, specificity, positive and
negative predictive values.
• Differences in sensitivity and specificity were calculated
using the McNemar test.

10. Results

11. Lowest
false
negative
Advance
ruled
out by
score

12. Results

13. Results

14. Discussion
• AIRS can used as a supporting tool for junior resident or
emergency doctors to rule out appendicitis in low
probability cases
• The findings of this study show that a low AIR score is as
accurate in excluding appendicitis, and a high score more
accurate at predicting appendicitis, than the clinical
assessment of a senior surgeon.
• A high specificity, greater than that of the Alvarado score,
make it well placed to be used as a decision support tool in
identifying patients at high probability of appendicitis.

19. CONCLUSION
• AIRS is accurate in diagnosing high
probability case
• AIRS is accurate in excluding low probability
case

20. CRITICAL APPRAISAL