Validation of the Appendicitis Inflammatory Response (AIR) score during pregnancy: A nested case-control study

Area of Science:

• Obstetrics and Gynecology
• Surgical Diagnostics
• Emergency Medicine

Background:

• Appendicitis diagnosis in pregnancy is challenging, with risks from both delayed and unnecessary surgery.
• Established clinical scores for appendicitis lack validation in pregnant populations.
• Accurate diagnosis is crucial to optimize pregnancy outcomes.

Purpose of the Study:

• To evaluate the diagnostic accuracy of the Appendicitis Inflammatory Response (AIR) score in pregnant women.
• To compare the AIR score's performance against diagnostic imaging for suspected appendicitis during pregnancy.

Main Methods:

• A nested case-control study using Swedish national health registries.
• Included 154 pregnant women who underwent appendectomy and 232 controls with suspected appendicitis but non-specific abdominal pain.
• Extracted data from medical records to assess AIR score and imaging diagnostic value.

Main Results:

• Diagnostic imaging showed low sensitivity (44.9%) and specificity (42.2%).
• The AIR score demonstrated strong diagnostic accuracy with an area under the curve of 0.88 for all appendicitis.
• The AIR score achieved 100% sensitivity for complicated appendicitis at a score of ≥4 and 97% specificity for all appendicitis at a score of ≥9.

Conclusions:

• The AIR score shows potential as a reliable tool for risk-stratifying pregnant women with suspected appendicitis.
• The study highlights the AIR score's superior diagnostic performance compared to imaging in this population.
• Further validation of the AIR score specifically in pregnant women is warranted.