Diagnostic efficiency of clinical RIPASA score in acute appendicitis: a prospective study

Manmohan Singh; Dharamanjai Kumar Sharma

doi:10.18203/2349-2902.isj20253455

Authors

Manmohan Singh Department of General Surgery, R.N.T. Medical College, Udaipur, Rajasthan, India
Dharamanjai Kumar Sharma Department of General Surgery, R.N.T. Medical College, Udaipur, Rajasthan, India

DOI:

https://doi.org/10.18203/2349-2902.isj20253455

Keywords:

Acute appendicitis, RIPASA score, CRP, WBC, Diagnostic accuracy, Predictive value

Abstract

Background: Accurate diagnosis of acute appendicitis (AA) remains a challenge in emergency surgical settings. The RIPASA score is a clinical tool developed to improve diagnostic accuracy, especially in Asian populations. This study aims to evaluate and compare the positive predictive value of biochemical markers (WBC, CRP) with the RIPASA score in diagnosing acute appendicitis.

Methods: This prospective, hospital-based comparative study was conducted at RNT Medical College, Udaipur. A total of 84 patients presenting with suspected acute appendicitis between January 2023 and July 2024 were included. Clinical evaluation was performed using the RIPASA score, and biochemical markers (WBC and CRP) were assessed. Histopathology confirmed the diagnosis. Diagnostic accuracy was evaluated through sensitivity, specificity, PPV, NPV, and ROC curves.

Results: The RIPASA score showed the highest diagnostic performance with an AUC of 0.87, sensitivity of 82.3%, and specificity of 89.1%. WBC count (>11,100/μl) had a sensitivity of 85.8% and specificity of 72.4% (AUC=0.781). CRP (>40.0 mg/L) showed moderate accuracy with 72.7% sensitivity and 76.5% specificity (AUC=0.56). RIPASA score showed a moderate positive correlation with WBC (Pearson’s r=0.47, p<0.01) and a strong positive correlation with CRP (Pearson’s r=0.61, p<0.01), while WBC and CRP also showed a weak but significant correlation (Pearson’s r=0.35, p<0.05).

Conclusion: RIPASA score is more reliable than CRP and correlated well with WBC in diagnosing acute appendicitis. Combining clinical scoring with selective biochemical markers enhances diagnostic accuracy.

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