ArticleLangenbeck's archives of surgery2022
Predicting complicated appendicitis based on clinical findings: the role of Alvarado and Appendicitis Inflammatory Response scores.
Article in Langenbeck's archives of surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 21 citations in OpenAlex.
- Integration of clinical information for identification of gangrenous or perforated appendicitis in children: a multicenter retrospective cohort study with external validation.BMC pediatrics · 2026Article
- Diagnostic Accuracy of Inflammatory Biomarkers in Differentiating Acute Appendicitis From Other Acute Abdomen and Predicting Disease Severity: A Prospective Comparative Cross-Sectional Study.Health science reports · 2026Article
- Development and internal validation of a risk-stratification model for complicated appendicitis in the elderly: a retrospective comparative study.BMC gastroenterology · 2026Article
- Diagnostic value of CAR, HALP, and SII for predicting complicated appendicitis: a reassessment of inflammatory indices.BMC surgery · 2026Article
- Predictive value of the HALP score in differentiating complicated and uncomplicated acute appendicitis.Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES · 2025Article
- Predictive Value of Clinical and CT Scan Findings for Complicated Appendicitis: A Retrospective Analysis.Cureus · 2025Article
- The Role of Hyponatremia in Identifying Complicated Cases of Acute Appendicitis in the Pediatric Population.Diagnostics (Basel, Switzerland) · 2025Article
- C-Reactive Protein, International Normalized Ratio, and Fibrinogen in Diagnostic Scale of Complicated Acute Appendicitis.Clinics and practice · 2025Article
- Diagnostic Value of Systemic Immune Inflammation Index in Identifying Complicated Acute Appendicitis Cases.Cureus · 2024Article
- Predicting severity of acute appendicitis with machine learning methods: a simple and promising approach for clinicians.BMC emergency medicine · 2024Article
- Article
- A "fruitful" cause of acute appendicitis.La Tunisie medicale · 2023Article
- A Bizarre Cause of Acute Appendicitis in a Pediatric Patient: An Ingested Tooth.Children (Basel, Switzerland) · 2023Article
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe pre-interventional differentiation between complicated and uncomplicated appendicitis is decisive for treatment. In the context of conservative therapy, the definitive diagnosis of uncomplicated appendicitis is mandatory. This study investigates the ability of clinical scoring systems and imaging to differentiate between the two entities.
methodsThis is a retrospective analysis of two cohorts from two tertiary referral centers in Switzerland and Germany. All consecutive patients underwent appendectomy between January 2008 and April 2013 (in the first cohort) or between January 2017 and June 2019 (the second cohort). Exclusion criteria did not apply as all patients found by the database search and received an appendectomy were included. Diagnostic testing and calculation of a receiver operating curve were performed to identify a cutoff for clinical scores that resulted in a minimum sensitivity of 90% to detect complicated appendicitis. The cutoff was combined with additional diagnostic imaging criteria to see if diagnostic properties could be improved.
resultsNine hundred fifty-six patients were included in the analysis. Two hundred twenty patients (23%) had complicated appendicitis, and 736 patients (77%) had uncomplicated appendicitis or no inflammation. The complicated appendicitis cohort had a mean Alvarado score of 7.03 and a mean AIR of 5.21. This compared to a mean Alvarado of 6.53 and a mean AIR of 4.07 for the uncomplicated appendicitis cohort. The highest Alvarado score with a sensitivity of > 90% to detect complicated appendicitis was ≧ 5 (sensitivity = 95%, specificity 8.99%). The highest AIR score with a sensitivity of > 90% to detect complicated appendicitis was ≧ 3 (sensitivity 91.82%, specificity 18.53). The analysis showed that additional CT information did not improve the sensitivity of the proposed cut-offs.
conclusionAIR and Alvarado scores showed limited capability to distinguish between complicated and uncomplicated appendicitis even with additional imaging in this retrospective cohort. As conservative management of appendicitis needs to exclude patients with complicated disease reliably, appendectomy seems until now to remain the safest option to prevent undertreatment of this mostly benign disease.
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