Department of Biomedical and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
Department of Surgery, County Hospital Ryhov, 551 85, Jönköping, Sweden.
World J Surg. 2021 Jul;45(7):2081-2091. doi: 10.1007/s00268-021-06042-2. Epub 2021 Apr 6.
Patients with suspicion of appendicitis present with a wide range of severity. Score-based risk stratification can optimise the management of these patients. This prospective study validates the Appendicitis Inflammatory Response (AIR) score in patients with suspicion of appendicitis.
Consecutive patients over the age of five with suspicion of appendicitis presenting at 25 Swedish hospital's emergency departments were prospectively included. The diagnostic properties of the AIR score are estimated.
Some 3878 patients were included, 821 with uncomplicated and 724 with complicated appendicitis, 1986 with non-specific abdominal pain and 347 with other diagnoses. The score performed better in detecting complicated appendicitis (ROC area 0.89 (95% confidence interval (CI) 0.88-0.90) versus 0.83 (CI 0.82-0.84) for any appendicitis, p < 0.001), in patients below age 15 years and in patients with >47 h duration of symptoms (ROC area 0.93, CI 0.90-0.95 for complicated and 0.87, CI 0.84-0.90 for any appendicitis in both categories). Complicated appendicitis is unlikely at AIR score <4 points (Negative Predictive Value 99%, CI 98-100%). Appendicitis is likely at AIR score >8 points, especially in young patients (positive predictive value (PPV) 96%, CI 90-100%) and men (PPV 89%, CI 84-93%).
The AIR score has high sensitivity for complicated appendicitis and identifies subgroups with low probability of complicated appendicitis or high probability of appendicitis. The discriminating capacity is high in children and patients with long duration of symptoms. It performs equally well in both sexes. This verifies the AIR score as a valid decision support. Trial registration number https://clinicaltrials.gov/ct2/show/NCT00971438.
怀疑患有阑尾炎的患者病情严重程度不一。基于评分的风险分层可以优化这些患者的管理。本前瞻性研究验证了怀疑阑尾炎患者的阑尾炎炎症反应（AIR）评分。
连续纳入年龄在 5 岁以上、疑似阑尾炎并就诊于瑞典 25 家医院急诊科的患者。评估 AIR 评分的诊断性能。
共纳入 3878 例患者，821 例为单纯性阑尾炎，724 例为复杂性阑尾炎，1986 例为非特异性腹痛，347 例为其他诊断。该评分在检测复杂性阑尾炎方面表现更好（ROC 曲线下面积 0.89（95%置信区间 0.88-0.90）与任何阑尾炎的 0.83（CI 0.82-0.84）相比，p<0.001），在年龄<15 岁的患者和症状持续时间>47 小时的患者中表现更好（ROC 曲线下面积为 0.93，CI 0.90-0.95 为复杂性阑尾炎，0.87，CI 0.84-0.90 为任何阑尾炎）。AIR 评分<4 分，复杂性阑尾炎可能性小（阴性预测值 99%，CI 98-100%）。AIR 评分>8 分，尤其是年轻患者（阳性预测值 96%，CI 90-100%）和男性（89%，CI 84-93%），阑尾炎可能性大。
AIR 评分对复杂性阑尾炎具有较高的敏感性，并确定了低复杂性阑尾炎或高阑尾炎可能性的亚组。在儿童和症状持续时间较长的患者中，该评分的区分能力较高。在男女两性中表现相同。这验证了 AIR 评分作为一种有效的决策支持工具。试验注册号：https://clinicaltrials.gov/ct2/show/NCT00971438。
