Optimization of the Diagnostic Algorithm in Appendicitis: The Role of Clinical Scores (Alvarado, AIR Score)

Introduction: Acute appendicitis remains a leading cause of emergency abdominal surgery. Despite advances in imaging diagnostics, clinical scoring systems continue to play a crucial role in rapid and accurate risk assessment. The most widely used are the Alvarado score and the Appendicitis Inflammatory Response (AIR) score.Materials and Methods: A retrospective single-center study was conducted on 124 patients operated for acute appendicitis at the Department of Hepatobiliary and Pancreatic Surgery, University Hospital “Alexandrovska,” between 2018 and 2025. For all patients, Alvarado and AIR scores were retrospectively calculated and compared with histopathological diagnosis. Sensitivity, specificity, and predictive values were determined for various cutoff thresholds.Results: An Alvarado score ≥7 demonstrated 82% sensitivity and 68% specificity, whereas an AIR score ≥5 achieved 88% sensitivity and 74% specificity. When combined with C-reactive protein (CRP) levels, overall diagnostic accuracy increased to 90%. Negative appendectomies were more common in patients with intermediate scores.Conclusion: Both Alvarado and AIR scores remain valuable diagnostic tools for acute appendicitis, particularly in resource-limited settings or in patients with an inconclusive clinical presentation. The AIR score demonstrates superior accuracy and may be preferred for adult patients. Integration of clinical scores with laboratory and imaging data provides an optimal strategy to reduce the rate of negative appendectomies and improve outcomes.