ULOGA OCJENSKE LJESTVICE ''AIR SCORE'' U DIJAGNOSTICI AKUTNOG APENDICITISA U DJEČJOJ DOBI

Objectives: The aim of this study was to evaluate the validity of „AIR score“ in decision-making process of diagnosing and treating acute appendicitis in children. Patients and methods: From January 1st 2019 until May 1st 2020 a prospective cross-sectional study was conducted with 190 pediatric patients who underwent appendectomy. Based on the calculated „AIR score“, they were assigned to low, medium or high probability risk groups of appendicitis. Patients were also divided into two groups, based on the intraoperative finding of perforated (Group I; n=38 patients) or non-perforated (Group II; n=146 patients) appendicitis. The diagnostic efficacy of the „AIR score“, as well as the potential for acute appendicitis risk stratification were quantified among the groups using recipient-operator curves. Results: Acute appendicitis was diagnosed in 184 (96.8%) patients. The median value of the “AIR score” in Group I was 10 (IQR 9, 11), while in Group II it was 7 (IQR 6, 9) (P<0.001). Based on the "AIR score", patients were stratified with high accuracy into low, medium and high risk groups for acute appendicitis (P<0.001). A cut-off value of 5 which was used to differentiate between low-risk and medium-risk patients showed 95.6% sensitivity and 50% specificity for the diagnosis of acute appendicitis. The area under the ROC curve for the detection of acute appendicitis was 0.89 (95% CI: 0.838-0.942; P<0.001). A cut-off value ≥9, which was used to differentiate patients at high risk for acute appendicitis, has been shown to be a good indicator of advanced stage of the disease. For a cut-off value ≥9, sensitivity was 89.5%, while specificity was 71.9%. The area under the ROC curve for the detection of perforated appendicitis was 0.80 (95% CI: 0.719-0.871; P<0.001). Conclusion: "AIR score" is a tool of high sensitivity and specificity in detecting acute appendicitis and distinguishing perforated from non-perforated appendicitis in children. The scale also stratifies patients with high accuracy into high, medium, or low risk groups for acute appendicitis. Nevertheless, „AIR score“ results should only be viewed as a valuable diagnostic addition and should not replace physical examination, imaging and laboratory tests in treatment decision-making of acute appendicitis in children.