Risk stratification by the Appendicitis Inflammatory Response score to guide decision-making in patients with...

Area of Science:

• Medical diagnostics
• Clinical decision support
• Surgical pathology

Background:

• Current management of suspected appendicitis faces challenges with over-admission and high rates of negative appendectomies.
• The Appendicitis Inflammatory Response (AIR) score offers potential for risk stratification to improve clinical decision-making.

Purpose of the Study:

• To assess the benefits of risk stratification using the AIR score in patients with suspected appendicitis.
• To evaluate the AIR score's performance in reducing admissions, optimizing imaging, and preventing unnecessary surgical explorations.

Main Methods:

• A prospective observational study was conducted over 50 weeks at a single institution.
• The AIR score was calculated for all patients admitted with suspected appendicitis.
• Appendicitis diagnosis was confirmed by histology; non-appendicitis cases were identified by negative histology or absence of surgery.

Main Results:

• The AIR score correctly classified 63.3% of patients with non-appendicitis pain as low risk, though 13 low-risk patients had appendicitis.
• Low-risk patients constituted 48.1% of admissions, 57% of negative explorations, and 50.7% of imaging requests.
• An AIR score of 5+ demonstrated high sensitivity (90%) for appendicitis, while a score of 9+ showed high specificity (97%) and identified advanced cases.

Conclusions:

• Risk stratification using the AIR score can guide clinical decisions for suspected appendicitis.
• Implementing the AIR score can lead to reduced hospital admissions and fewer negative surgical explorations.
• The AIR score aids in optimizing the use of diagnostic imaging, improving efficiency and patient care.