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Table 2 Comparison of the most popular and validated clinical scores for the diagnosis of AA

From: WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis

  Alvarado scorea AIR scoreb PAS scorec RIPASA scored AAS scoree
Vomiting   1    
Nausea or vomiting 1   1 1  
Anorexia 1   1 1  
Pain in RIFf 2 1   0.5 2
Migration of pain to the RIFf 1   1 0.5 2
Rovsing’s sign     2  
RIFg tenderness    2 1  
 Women >50 years or men (any age)      3
 Women <50 years      1
Rebound tenderness or muscular defense/guarding 1    1 + 2  
 Light   1    2
 Medium   2    4
 Strong   3    4
Body temperature      
  > 37.5 °C 1   1   
  > 38.5 °C   1    
  > 37– <39 °C     1  
WBC (white blood cell) count    
  > 10.0 × 109/l 2   1 1  
 10.0–14.9 × 109/l   1    
  ≥ 15.0 × 109/l   2    
  ≥ .2 and <10.9 × 109/l      1
  ≥ 10.9 and <14.0 × 109/l      2
  ≥ 14.0 × 109/l      3
Leukocytosis shift 1     
Polymorphonuclear leukocytes    
 70–84 %   1    
  ≥ 75 %    1   
  ≥ 85 %   2    
  ≥ 62 % and < 75 %      2
  ≥ 75 % and < 83 %      3
  ≥ 83 %      4
CRP (C-reactive protein) concentration    
 10–49 mg/l   1    
  ≥ 50 mg/l   2    
Symptoms <24 h and CRP (C-reactive protein) concentration    
  ≥ 4 and <11 mg/l      2
  ≥ 11 and <25 mg/l      3
  ≥ 25 and <83 mg/l      5
  ≥ 83 mg/l      1
Symptoms >24 h and CRP (C-reactive protein) concentration    
  ≥ 12 and <53 mg/l      2
  ≥ 53 and <152 mg/l      2
  ≥ 152 mg/l      1
Coughing/hopping/percussion pain    2   
Gender      
 Male     1  
 Female     0.5  
Age      
  < 40 years     1  
  ≥ 40 years     0.5  
Duration of symptoms      
  < 48 h     1  
  > 48 h     0.5  
Negative urinalysis     1  
Total score 10 12 10 16.5 23
  1. aAlvarado score: sum 0–4 = not likely appendicitis, sum 5–6 = equivocal, sum 7–8 = probably appendicitis, sum 9–10 = highly likely appendicitis
  2. bAcute appendicitis response score (AIR): sum 0–4 = low probability, sum 5–8 = indeterminate group, sum 9–12 = high probability [161]
  3. cPediatric appendicitis score (PAS): ≥6 = appendicitis, ≤5 = observe
  4. dRaja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score
  5. eAdult Appendicitis Score (AAS): low risk (0–10 points), intermediate risk (11–15 points), high risk (≥16 points)
  6. f right iliac fossa