{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T02:07:05Z","timestamp":1792548425961,"version":"4.5.0"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2015,3,2]],"date-time":"2015-03-02T00:00:00Z","timestamp":1425254400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,3,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Current management of suspected appendicitis is hampered by the overadmission of patients with non-specific abdominal pain and a significant negative exploration rate. The potential benefits of risk stratification by the Appendicitis Inflammatory Response (AIR) score to guide clinical decision-making were assessed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>During this 50-week prospective observational study at one institution, the AIR score was calculated for all patients admitted with suspected appendicitis. Appendicitis was diagnosed by histological examination, and patients were classified as having non-appendicitis pain if histological findings were negative or surgery was not performed. The diagnostic performance of the AIR score and the potential for risk stratification to reduce admissions, optimize imaging and prevent unnecessary explorations were quantified.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 464 patients were included, of whom 210 (63\u00b73 per cent) with non-appendicitis pain were correctly classified as low risk. However, 13 low-risk patients had appendicitis. Low-risk patients accounted for 48\u00b71 per cent of admissions (223 of 464), 57 per cent of negative explorations (48 of 84) and 50\u00b77 per cent of imaging requests (149 of 294). An AIR score of 5 or more (intermediate and high risk) had high sensitivity for all severities of appendicitis (90 per cent) and also for advanced appendicitis (98 per cent). An AIR score of 9 or more (high risk) was very specific (97 per cent) for appendicitis, and the majority of patients with appendicitis in the high-risk group (21 of 30, 70 per cent) had perforation or gangrene. Ultrasound imaging could not exclude appendicitis in low-risk patients (negative likelihood ratio (LR) 1\u00b70) but could rule-in the diagnosis in intermediate-risk patients (positive LR 10\u00b72). CT could exclude appendicitis in low-risk patients (negative LR 0\u00b70) and rule-in appendicitis in the intermediate group (positive LR 10\u00b79).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Risk stratification of patients with suspected appendicitis by the AIR score could guide decision-making to reduce admissions, optimize utility of diagnostic imaging and prevent negative explorations.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/bjs.9773","type":"journal-article","created":{"date-parts":[[2015,3,2]],"date-time":"2015-03-02T10:11:35Z","timestamp":1425291095000},"page":"563-572","source":"Crossref","is-referenced-by-count":73,"title":["Risk stratification by the Appendicitis Inflammatory Response score to guide decision-making in patients with suspected appendicitis"],"prefix":"10.1093","volume":"102","author":[{"given":"A J","family":"Scott","sequence":"first","affiliation":[{"name":"Academic Surgical Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK"},{"name":"Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S E","family":"Mason","sequence":"additional","affiliation":[{"name":"Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Arunakirinathan","sequence":"additional","affiliation":[{"name":"Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y","family":"Reissis","sequence":"additional","affiliation":[{"name":"Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J M","family":"Kinross","sequence":"additional","affiliation":[{"name":"Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J J","family":"Smith","sequence":"additional","affiliation":[{"name":"West Middlesex University Hospital NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2015,3,2]]},"reference":[{"key":"2021022218210732100_bjs9773-bib-0001","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1002\/bjs.9347","article-title":"Improving outcomes in emergency surgery","volume":"101","author":"Bergenfelz","year":"2014","journal-title":"Br J Surg"},{"key":"2021022218210732100_bjs9773-bib-0002","doi-asserted-by":"crossref","first-page":"e3","DOI":"10.1002\/bjs.9327","article-title":"Barriers, regulations and solutions in emergency surgery research","volume":"101","author":"Coats","year":"2014","journal-title":"Br J Surg"},{"key":"2021022218210732100_bjs9773-bib-0003","volume-title":"Emergency Surgery: Standards for Unscheduled Surgical Care","author":"Royal College of Surgeons of England (RCS)","year":"2011"},{"key":"2021022218210732100_bjs9773-bib-0004","doi-asserted-by":"crossref","first-page":"e134","DOI":"10.1002\/bjs.9325","article-title":"A traffic-light coding system to organize emergency surgery across surgical disciplines","volume":"101","author":"Leppaniemi","year":"2014","journal-title":"Br J Surg"},{"key":"2021022218210732100_bjs9773-bib-0005","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.1002\/bjs.9326","article-title":"Organization of emergency surgery","volume":"101","author":"Lepp\u00e4niemi","year":"2014","journal-title":"Br J Surg"},{"key":"2021022218210732100_bjs9773-bib-0006","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1002\/bjs.9605","article-title":"Implementation of an acute surgical admission ward","volume":"101","author":"Eijsvoogel","year":"2014","journal-title":"Br J Surg"},{"key":"2021022218210732100_bjs9773-bib-0007","doi-asserted-by":"crossref","first-page":"e141","DOI":"10.1002\/bjs.9320","article-title":"Effect of the introduction of an emergency general surgery service on outcomes from appendicectomy","volume":"101","author":"Suen","year":"2014","journal-title":"Br J Surg"},{"key":"2021022218210732100_bjs9773-bib-0008","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1007\/BF02957857","article-title":"Surgical emergencies in Ireland. 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