COMPARATIVE ANALYSIS OF ACUTE INFLAMMATORY SCORE (AIR) AND ALVARADO SCORE IN DIAGNOSING ACUTE APPENDICITIS AT A TERTIARY CARE HOSPITAL

Abstract

Objective: To determine the diagnostic accuracy of the Alvarado score and AIR score in diagnosing acute appendicitis taking histopathology as gold standard. Study Design: Cross Sectional (Validation) Study. Place and duration of study: Department of Surgery, Holy Family Hospital, Rawalpindi from March 2026 to July 2026. Methodology: We enrolled 97 cases presented to the ER department with suspected of acute appendicitis. The acute appendicitis was considered on the basis of a clinical diagnosis confirmed through surgical findings, histopathological examination, or imaging. The cut off value of Alvarado score was ≥7 or higher on Alvarado scale. AIR score was calculated on the basis of scoring system that assesses inflammation severity based on laboratory results and clinical findings. A score of ≥ 9 AIR scale was considered as cutoff. All patients underwent routine laboratory and ultrasound investigation and their Alvarado and AIR scores were recorded before undergoing to surgery. Histopathology samples were sent to hospital laboratory for confirmation of acute appendicitis. The results of histopathology were correlated with preoperative scores and diagnostic accuracy of Alvarado and AIR score were calculated. Results: Of 97 cases, male subjects 65(67%) and younger age range i.e. 18-30 years was commonly recorded. The sensitivity of Alvarado score was 63/78(80.8%), specificity was 17/19(89.5%), positive predictive value(PPV) was recorded a 63/65(96.9%), negative predictive value(NPV) 17/32(53.1%)and diagnostic accuracy(DA) was 80/97(82.5%) whereas these findings AIR score were recorded as 58/78(74%), 18/19(94.7%), 58/59(98.3%), 18/38(47.4%) and 76/97(78.4%) respectively.Conclusion: Overall, both Alvarado and AIR scores demonstrated good diagnostic utility. Alvarado provided greater sensitivity and slightly higher fixed-cut-off accuracy, whereas AIR offered greater specificity and numerically stronger ROC discrimination.