Risk Predictable Value Of Improved Alvarado Score,AIR Score,RIPASA Score,and AAS Score For The Risk Of Acute Appendicitis In Adults

backgroundAcute appendicitis AA is the most common indication for emergency abdominal surgery,with a lifetime prevalence of AA of about 14%.Although AA is common,there is insufficient understanding of the etiology of AA and a lack of reliable criteria for determining disease severity.Because different treatments(conservative or surgical)are chosen depending on the severity of AA disease,it is clinically important to accurately diagnose and assess the severity of AA.The lack of current clinical research has led to inaccurate diagnosis of AA and inaccurate judgment of disease severity,followed by differences in treatment and possible differences in prognosis.At present,the diagnostic accuracy and severity of domestic AA are still challenging for clinicians,requiring a comprehensive combination of clinical symptoms,signs,laboratory tests and imaging results.Over-dependence.The AA scoring system integrates clinical symptoms,signs and laboratory tests for the analysis and verification of AA diagnostic accuracy,and has certain clinical application value.The 2020 World Association of Emergency Surgery’s latest Guidelines for the Diagnosis and Treatment of Acute Appendicitis recommends Alvarado(Alvarado score),AIR(Appendicitis Inflammatory Response Score),RIPASA(Raja Isteri Pengiran Anak Saleha)and AAS(Adult Appendicitis).Score)four scores to diagnose AA and note that these four scores have some value for risk stratification in AA.Among them,Alvarado scores have gradually been replaced by more simplified and practical improved Alvarado(Modified Alvarado score)scores.Objective1 In this study,we applied improved Alvarado,AIR,RIPASA and AAS scores to verify whether AA patients at Qingdao University Hospital needed surgery and assess the severity of AA.2 In the four AA scoring systems,the score of the best risk prediction value suitable for the Qingdao area is preferred;Assess the ability of the four scores to determine the severity of AA.Method1.Retrospectively collect the "Medical Research Big Data Platform" of the Affiliated Hospital of Qingdao University from June 1,2019 to December 31,2020,during which cases of suspicious appendicitis combined with inpatient surgery were diagnosed,and there were pathological examination results.Of the 396 patients who met the inclusion criteria,127 cases of related diseases and other diseases affecting the results of this study were excluded according to the requirements of this study,and 269 cases eligible for study were selected for statistical analysis after screening,including 50 cases of acute simple appendicitis,153 cases of acute purulent appendicitis,and 66 cases of acute gangrene/perforated appendicitis.2.Collect basic information,clinical data and relevant laboratory examination indicators of all cases that meet the inclusion criteria.3.Using SPSS 27.0 statistical analysis,qualitative data is described in numbers(percentages)or median(interquartile spacing),quantitative data mean ± standard deviation representation or Mann-Whitney U test.The comparison of qualitative data between the three groups was a chi-square test and a Kruskal-Wallis H test was used for quantitative data.Between the three groups,two pairs of comparisons were made,and multiple comparisons between multiple samples based on a completely random design were used,and the corrected significance indicated that the difference was statistically significant,and P <0.05 indicated that the difference was statistically significant.The sensitivity,specificity,and area under the curve for the assessment of acute appendicitis classification in adults were calculated using the ROC curve.The image curve is drawn using Graphpad Prism 8.outcomeIn this study,all four scores were statistically significant for the prediction of complicated appendicitis(P<0.001),with the largest area under the ROC curve being the AAS score.The RIPASA score was not statistically significant in predicting gangrene/perforated appendicitis(P>0.05),and the remaining three scores were statistically significant in assessing the perforation of acute appendicitis gangrene(P <0.05),with the largest area under the ROC curve being the modified Alvarado score.2 Of the AA two-two comparisons of three severities in the postoperative pathological outcomes,four scores were statistically significant for distinguishing between simple and purulent appendicitis,simple and gangrene/perforated appendicitis(P <0.001),but four scores were not statistically significant for distinguishing between purulent and gangrene/perforated appendicitis(P>0.05).Conclusion:1 Four scores from this study were clinically valuable in predicting the need for appendectomy in adult AA patients,with the AAS score having the best screening performance.2Improved Alvarado scores,AIR scores,and AAS scores can help clinicians assess whether adult AA patients need an emergency,and the best assessment effectiveness is to improve the Alvarado score.3 In judging the severity of AA,the four scores have good predictive value in preoperative assessment of whether adult AA is simple appendicitis;However,preoperative inability to distinguish between purulent or gangrene/perforated appendicitis.So four scores have some value in assessing the severity of adult AA,but they cannot fully distinguish the severity of adult AA.