Nikolay Penkov, Boris Kunev, Yavor Asenov, Georgi Jelev, Todor Yanev, Teofil Sedloev

Acute appendicitis – clinical symptoms and scoring systems

Introduction

Acute appendicitis – clinical symptoms and scoring systems. Acute appendicitis: Explore clinical symptoms, diagnostic challenges, and key scoring systems (Alvarado, AIR) for accurate diagnosis, reducing unnecessary surgeries.

Abstract

Acute appendicitis is the most common cause of acute abdominal surgery, with a peak incidence between 10 and 30 years of age and an annual prevalence of approximately 100 per 100,000 people. Despite well-established diagnostic and therapeutic algorithms, early diagnosis remains challenging, especially in children, elderly patients, pregnant women, and those with atypical appendix locations. The disease follows a dynamic inflammatory progression with three main stages—catarrhal, phlegmonous, and gangrenous—each associated with characteristic clinical and morphological features.The clinical diagnosis is based on symptom chronology, with migratory pain, anorexia, nausea, and localized tenderness in the right iliac fossa as key indicators. Numerous classical physical signs (Blumberg, Rovsing, Psoas, Obturator, Sitkovski, etc.) remain useful in clinical evaluation. However, no single clinical or laboratory marker is sufficiently specific; hence, scoring systems have become integral to modern diagnostic algorithms.Among the most widely used models, the Alvarado and Appendicitis Inflammatory Response (AIR) scores show the best combination of sensitivity and specificity. Pediatric populations benefit from the PAS, while newer tools such as RIPASA, MZXBTCH, and Sammalkorpi scores offer improved stratification of complicated appendicitis. A balanced approach that integrates clinical judgment, validated scoring systems, and selective imaging (ultrasound or CT) provides optimal diagnostic accuracy and reduces unnecessary surgeries.

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