Risk Stratification by the Appendicitis Inflammatory Response Score to Guide Decision Making in Patients with Suspected Appendicitis

Abstract

Background: Acute appendicitis is the commonest surgical emergency, yet accurate diagnosis remains challenging. Risk stratification with the AIR score provides objective evaluation based on laboratory parameters. Aims: To assess the potential benefits of risk stratification to guide clinical decision making. Methods: This prospective observational study was conducted in the Department of Surgery, Dhaka Medical College & Hospital over a period of one year. The patients who were admitted as suspected cases of acute appendicitis are enrolled in this study. Data were collected in a pre-designed data collection sheet including particulars of the patients, detailed history, clinical examination, pre-existing co-morbidities and relevant investigations. Results: According to inflammatory Response Score it was observed of the 108 patients, 33 (30.6%) were classified as high-risk (AIR score 9–12), of whom 31 (93.9%) had histopathologically confirmed appendicitis and 2 (6.1%) were negative. The AIR score demonstrated sensitivity of 92.3%, specificity of 62.5%, accuracy of 87.2%, positive predictive value (PPV) of 92.3%, and negative predictive value (NPV) of 62.5%. The likelihood ratio for a positive result (LR+) was 2.46 and for a negative result (LR–) was 0.12. In the intermediate-risk group (AIR score 5–8), 48 patients (44.4%) had a 50% positive rate, while low-risk patients (AIR score 0–4; n=27, 25.0%) exhibited a 14.8% positivity, guiding tailored imaging and management decisions. The overall negative appendectomy rate was 12.8%.  Conclusion: AIR score has a significant diagnostic value in the diagnosis of acute appendicitis and majority of the high-risk group has a statistically significant value. AIR score could guide decision-making to reduce hospital admissions, optimize utility of diagnostic imaging and reduce negative exploration.