Comparison of Alvarado and RIPASA scoring systems in diagnosis of acute appendicitis and correlation with intraoperative and histopathological findings

Mahendra Kumar Regar; Ganpat Singh Choudhary; Chandrakanta Nogia; Dharmendra Kumar Pipal; Anand Agrawal; Harshit Srivastava

doi:10.18203/2349-2902.isj20171634

Authors

Mahendra Kumar Regar Department of Surgery, Dr. S.N. Medical College Jodhpur, Rajasthan, India
Ganpat Singh Choudhary Department of Surgery, Dr. S.N. Medical College Jodhpur, Rajasthan, India
Chandrakanta Nogia Department of Pathology, Dr. S.N. Medical College Jodhpur, Rajasthan, India
Dharmendra Kumar Pipal Department of Surgery, Dr. S.N. Medical College Jodhpur, Rajasthan, India
Anand Agrawal Department of Surgery, Dr. S.N. Medical College Jodhpur, Rajasthan, India
Harshit Srivastava Department of Surgery, Dr. S.N. Medical College Jodhpur, Rajasthan, India

DOI:

https://doi.org/10.18203/2349-2902.isj20171634

Keywords:

Accuracy, Acute appendicitis, Alvarado score, Negative appendicectomy rate, RIPASA score

Abstract

Background: Despite extraordinary advances in modern radiology and laboratory investigations an accurate diagnosis of acute appendicitis cannot be made in atypical cases. No single diagnostic aid can dramatically reduce the rate of negative appendicectomy.

Methods: To reduce the rate of negative appendicectomies, application of RIPASA and Alvarado scoring done in every clinically diagnosed cases of appendicitis in a prospective study from January 2015 to January 2016 was done. 100 patients with right lower quadrant abdominal pain fulfilling the inclusion and exclusion criterion underwent appendicectomy in Mahatma Gandhi Hospital, Dr. S.N. Medical college, Jodhpur, Rajasthan, India.

Results: The results of both scoring system were reported and were correlated with intraoperative and histopathological findings. Chi-square test was applied to calculate the p-value for the association between the variables of studied. The mean age was 24.86 years (10-80 years) and there were 61 males and 39 females in the study. Histopathological examination confirmed appendicitis in 95 patients with 5 negative appendicectomies. Negative appendicectomy rate for RIPASA and Alvarado score was 2.17% and 1.54% respectively. Accuracy for RIPASA and Alvarado score was 93% and 68% respectively.

Conclusions: RIPASA score is a more valuable tool for diagnosing acute appendicitis with 93% accuracy, sensitivity 94.74% and specificity 60%; inspite of sophisticated investigations like CT, thus reducing the cost of treatment and minimize negative appendicectomy rate.

Metrics

Metrics Loading ...

References

Chaurasia BD. Human anatomy regional and applied; 7th ed. 2016;2:295-298.

Stephens PL, Mazzucco JJ. Comparison of ultrasound and Alvarado score for the diagnosis of acute appendicitis. Conn Med. 1999;63:137-40.

Ozao-Choy J, Kim U, Vieux U, Menes TS. Incidental findings on computed tomography scans for acute appendicitis: prevalance, costs and outcome. Am Surg. 2011;77:1502-9.

Petrosyan M, Estrada J, Chan S, Somers S, Yacoub WN, Kelso RL,et al. CT scan in patients with suspected appendicitis: Clinical implications for the acute care surgeon. Eur Surg Res. 2008;40(2):211-9.

Alvarado A. A practical score for early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15:557-64.

Kalan M, Talbot D. Evaluation of the modified alvarado score in the diagnosis of acute appendicitis-a prospective study: Ann Coll Surg Engl. 1994;76:418-9.

Chong CF, Adi MIW, Thien A, Suyoi A, Mackie AJ, Tin AS, et al. Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis. Singapore Med J. 2010;51:220-5.

Andreou P, Blain S, Boulay CEH. A histopathological study of appendix at autopsy and after surgical resection. Histopathology. 1990;17:427-31.

Williams GR. Presidential address: A history of appendicitis. Ann Surg. 1983;197:495-506.

Flum DR, Morris A, Koepsell T, Dellinger EP. Has misdiagnosis of appendicitis decreased over time? A population based analysis. JAMA. 2001;286:1748-53.

Korner H, Sondenaa K, Soreide JA, Nystad A, Vatten C. The history is important with suspected appendicitis. Dig Surg. 2000;17(4):364-8.

Jawaid A, Asad A, Motiei, Munir A, Bhutto E, Choudry H, et al. Clinical scoring system: a valuable tool for decision making in cases of acute appendicitis. J Pak Med Assoc. 1999;49:254-9.

Baidya N, Rodrigues G, Rao A, Khan SA. Evaluation of Alvarado score in acute appendicitis: a prospective study. Internet J Surg. 2007;9:1-3.

Chan MY, Teo BS, Ng BL. The Alvarado score and acute appendicitis. Ann Acad Med Singapore. 2001;30:510-2.

Khan I, Ur Rehman A. Application of Alvarado scoring in diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad. 2005;17:41-4.

Jang SO, Kim BS, Moon DJ. Application of Alvarado score in patients with suspected appendicitis. Korean J Gastroentrol. 2008;52:27-31.

Chong CF, Thien A, Mackie AJ, Tin AS, Tripathi S, Ahmad MA, Tan LT, Ang SH, Telisinghe PU. Comparison of RIPASA and Alvarado scores for the diagnosis of acute appendicitis. Singapore Med J. 2011;52(5):340-5.