# Evaluation of the predictive value of scoring systems in diagnosis of acute appendicitis: a comparative prospective study

## TL;DR

This study compares different scoring systems for diagnosing acute appendicitis and finds that the Adult Appendicitis Score (AAS) performs best.

## Contribution

The study evaluates and compares the diagnostic accuracy of four scoring systems for acute appendicitis in a prospective clinical setting.

## Key findings

- The AAS score showed the highest diagnostic accuracy with an AUC of 0.988.
- AAS and AIR scores had high sensitivity and overall accuracy compared to other systems.
- Alvarado score had lower accuracy with an AUC of 0.715.

## Abstract

Acute Appendicitis stands as the leading cause of acute abdominal pain necessitating surgical intervention in the world. The initial clinical assessment of patients suspected of having acute appendicitis remains crucial. The aim is to quickly confirm or rule out the diagnosis to minimize delays, avoid unnecessary surgeries.

The aim of our study is to evaluate the predictive value of multiple scoring systems for Diagnosis of acute appendicitis cases with correlation between scores prediction results and surgical interventions results.

This a prospective study carried out in Mansoura university hospitals and Mansoura emergency hospital in the period between December 2024 and June 2025. Patients included in the study were admitted at emergency department of General Surgery at Mansoura University Hospital. The study was explained in details to the whole patients sharing in the study and a written informed consent was taken from all the patients.

All patient presented with suspected acute appendicitis were subjected to four scores with comparing between them : Alvarado score, Appendicitis Inflammatory Response score (AIR), The RIPASA (Raja Isteri Pengiran Anak Saleha Appendicitis) score and AAS (Adult Appendicitis Score).

ROC curve analysis demonstrated variable diagnostic performance among the evaluated scoring systems for acute appendicitis. The Adult Appendicitis Score (AAS) showed the highest discriminatory ability with an AUC of 0.988 (p = 0.001), followed by the Appendicitis Inflammatory Response (AIR) score (AUC = 0.920, p = 0.005) and the RIPASA score (AUC = 0.825, p = 0.03). The Alvarado score demonstrated comparatively lower accuracy (AUC = 0.715, p = 0.155). At their respective optimal cutoff points, AAS and AIR achieved high sensitivity and overall accuracy, with AAS demonstrating an apparent specificity of 100%. These findings suggest superior diagnostic performance of AAS and AIR compared with Alvarado and RIPASA in the studied population.

Among the evaluated clinical scoring systems, the Adult Appendicitis Score (AAS) and the Appendicitis Inflammatory Response (AIR) score demonstrated the highest diagnostic accuracy for acute appendicitis, with AAS showing the best overall performance. These scoring systems may represent reliable tools for supporting clinical decision-making and improving diagnostic confidence, potentially reducing unnecessary imaging or negative appendectomies. However, further validation in larger, more diverse cohorts is required before firm recommendations can be made.