Diagnostic scores for acute appendicitis in geriatric patients: is there any predictive value?

Introduction: Appendectomy is the most common emergency surgical procedure. In old age, the risk of perforation and mortality increases. Various diagnostic scales exist but are not commonly applied to geriatric patients, and their compatibility with this population is unknown. Methods: A retrospective observational study was conducted on 41 patients over 60 years old with a clinical suspicion of acute appendicitis who underwent surgical treatment and confirmatory diagnosis by histopathology. The Raja Isteri Pengiran Anak Saleha (RIPASA), appendicitis inflammatory response (AIR), and Alvarado scales were selected, and their diagnostic accuracy was compared. A 95% confidence interval and a significant value of P < 0.05 were used. Results: The average age was 64 years, with most being women (60.9%). Three scales were used in this study: AIR score, RIPASA, and Alvarado. The median score for the AIR scale was 7 (interquartile range: 8–5), RIPASA 7.5 (10–6), and Alvarado 7 (9–5). The Alvarado scale had an area under the curve (AUC) of 0.538, AIR score an AUC of 0.488, and RIPASA an AUC of 0.541, with RIPASA being the best performer. Conclusion: The results of this study highlight a potential area of research for designing scales focused on geriatric patients, considering the various variables associated with the suspicion of acute appendicitis. This would help optimize primary care and improve the approach for patients with symptoms suggestive of appendicitis.