ABSTRACT
Background: Acute appendicitis is mostly considered a clinical diagnosis and many surgeons resort to clinical judgement for deciding its management. Such cases often pose a diagnostic dilemma and result in significant negative exploration rates. Appendicitis Inflammatory Response (AIR) score, designed in 2008, is a validated clinical scoring system which has outperformed the well-known Alvarado scoring system. This study evaluates the risk stratification of patients as per AIR scores, correlation with the post-op histopathological examination (HPE) diagnosis to calculate the negative appendicectomy rate and to evaluate the diagnostic performance of this scoring system. Method:This is a prospective observational study carried out between Nov 2016 and May 2018, on 150 cases of acute appendicitis that underwent surgical management. Result: This study data revealed a negative appendicectomy rate of 9.33 %. Statistical analysis showed that scores of 9 - 12 has great accuracy for diagnosis, with a specificity of 100 % and positive predictive value of 1.0 whereas low scores of 0-4 potentially identify cases who do not require surgery. Conclusion:The AIR score is an accurate diagnostic tool when a score of 9 is taken as cut-off. Management algorithms based on AIR score have the potential of reducing negative appendicectomy rate by correct identification of those who don't require surgery.
ABSTRACT
Background:Acute appendicitis is the most common cause of acute abdomen. Approximately 7% of the population will be affected by this condition during full life. The development of AIR score may contribute to diagnosis associating easy clinical criteria and two simple laboratory tests.Aim:To evaluate the score AIR (Appendicitis Inflammatory Response score) as a tool for the diagnosis and prediction of severity of acute appendicitis.Method:Were evaluated all patients undergoing surgical appendectomy. From 273 patients, 126 were excluded due to exclusion criteria. All patients were submitted o AIR score.Results:The value of the C-reactive protein and the percentage of leukocytes segmented blood count showed a direct relationship with the phase of acute appendicitis.Conclusion:As for the laboratory criteria, serum C-reactive protein and assessment of the percentage of the polymorphonuclear leukocytes count were important to diagnosis and disease stratification.
Racional:A apendicite aguda é a causa mais frequente de abdome agudo. Aproximadamente 7% da população será acometida por ela durante a vida. O desenvolvimento do escore Appendicitis Inflammatory Response (AIR) contribui para o diagnóstico através de critérios clínicos de fácil aplicabilidade e dois exames laboratoriais simples.Objetivo:Avaliar os critérios de AIR como ferramenta para o diagnóstico e predição da gravidade dos casos de apendicite aguda.Método:Foram avaliados todos os pacientes submetidos à apendicectomia. Do total de 273 pacientes 126 foram excluídos devido ao não cumprimento dos critérios de inclusão. Todos foram submetidos ao escore.Resultados:Quanto ao escore de AIR todos os pacientes do estudo se alocaram nos subgrupos de moderada (65,3%) e alta probabilidade (34,7%) para apendicite aguda. O valor da proteína C reativa e a porcentagem de segmentados no leucograma apresentaram relação direta com a fase da apendicite aguda.Conclusão:A dosagem sérica da proteína C reativa e avaliação do percentual de segmentados no leucograma mostraram ser importantes para o diagnóstico e a estratificação da fase evolutiva da doença.