الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Appendicitis represents a common cause of abdominal pain, which is in turn a leading presenting symptom among care seekers in emergency departments, with a lifetime risk of 9% of the population. It mostly occurs in adolescents and young adults, with slight sex‑related incidence discrepancy, as men are more affected than women.
Considering the malpractice claims for practicing emergency physicians, missed appendicitis comes third after missed myocardial infarction and fractures, and this clearly reflects the dilemma in diagnosis of appendicitis, especially in women in childbearing period,
old people, and those with atypical presentations, On one hand, the delay in diagnosis of appendicitis, by caused either observation in equivocal cases or time‑consuming investigations in straightforward diagnoses, can lead to complications such as perforation with increased morbidity and mortality.
On the other hand, negative appendectomy rate is estimated to be approximately 15–30%, particularly in cases operated based on a clinical decision, and this is not costless and a safe procedure, but causes an early complication rate of 7–13%.
In modern practice, the imaging study of choice for suspected appendicitis in adults is computed tomography (CT), which reduced negative appendectomy rates to less than 10%. Nevertheless, a single exposure event of CT to the abdomen and pelvis has an additional cancer risk of 0.2% in a 30‑year‑old healthy person. Given this fact, the imaging has an enduring cost.
With the aim to overcome these challenges, different scoring systems have been proposed. A common feature of these scores is to combine symptoms, signs and laboratory results to classify the patients into categories.
Alvarado score and appendicitis inflammatory score (AIS) are commonly used ones. However, their reliability is still questionable. In 2014, published a newly constructed score, the adult appendicitis score (AAS), with promising results. In this study, we aimed at comparing the reliability of the AAS versus the Alvarado and AIS. This should yield a well‑structured clinical guidance in the emergency service, with subsequent better outcomes and less cost.
This was non-interventional, cross-sectional study Over 16 months from January 2016 to April 2017, eligible patients ≥16 years old, presented to the emergency service of Menoufia university hospital with right lower quadrant (RLQ) pain, were enrolled in the study after taking their consent. The research protocol was approved by the ethical approval committee of Menoufia faculty of medicine.
In order to avoid the selection bias which would have been caused by the discrepancy in pain perception between males and females, a 1:1 gender ration (i.e 50%males + 50% females) was targeted during the study recruitment period
All surgically removed appendices were sent for histopathological examination, along with a detailed report. Labelling a case as ―positive appendicitis‖ was confirmed when pathological examination showed transmural infiltration with neutrophils in the appendix.
AAS was the most specific one at score 16, with specificity 97.9% and positive and predictive value 97.4%, whereas the appendicitis inflammatory response score was the most sensitive at score 5, with sensitivity and negative predictive values of 100%. Using the receiver operating characteristic curves showed the AAS was the most reliable, with area under the curve of 0.936 (P = 0.00).