A study to compare RIPASA (Raja Isteri Pengiran Anak Saleha Appendicitis) and Alvarado scores in diagnosing acute appendicitis in Indian population
DOI:
https://doi.org/10.18203/2349-2902.isj20181591Keywords:
Appendicitis, Alvarado, RIPASA, Scoring systemAbstract
Background: Acute appendicitis is one of the most common surgical emergencies. Various clinical scoring systems have been used for early diagnosis of acute appendicitis, of which Alvarado score is the most popular but it is found to be less accurate when applied to Asian population compared to RIPASA score. Radiological modalities such as computed tomography (CT) imaging may aid in making a definite diagnosis but will inflate the cost of treatment. This study aims to compare RIPASA and Alvarado scoring system in the diagnosis of acute appendicitis in our population.
Methods: It was a comparative cross-sectional study done in 100 patients. RIPASA and Alvarado scores were applied to each patient. Our inclusion criteria were patients presenting with Right iliac fossa pain who subsequently underwent Appendicectomy in the same admission. Exclusion criteria included patients admitted under other specialties, those who underwent previous appendicectomy, elective appendicectomy and those not willing for the study.
Results: The sensitivity and specificity of RIPASA score was 95.12% and 66.67% and that of ALVARADO score was 64.63% and 77.78%. The positive predictive value (PPV) and negative predictive value (NPV) of RIPASA score was 92.86% and 75% and that of Alvarado score was 92.98% and 32.5%. The diagnostic accuracy of Alvarado and RIPASA scores were 67.0% and 90.0% respectively.
Conclusions: RIPASA scoring system is more accurate and specific scoring system for our population than Alvarado in diagnosing acute appendicitis.
References
Stephens PL, Mazzucco JJ. Comparison of ultrasound and the Alvarado score for the diagnosis of acute appendicitis. Conn Med. 1999;63(3):137-40.
Mohebbi HA, Mehrvarz S, Kashani MT, Kabir A, Moharamzad Y. Predicting negative appendectomy by using demographic, clinical, and laboratory parameters: a cross-sectional study. Int J Surg. 2008;6(2):115-8.
Wani MM, Yousaf MN, Khan MA, Baba Abdul A, Durrani M, Wani MM, et al. Usefulness of the Alvarado scoring system with respect to age, sex and time of presentation, with regression analysis of individual parameters. Internet J Surg. 2007;11(2).1-5
Chong CF, Adi MI, 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(3):220-25.
Chong CF, Thien A, Mackie AJ, Tin AS, Tripathi S, Ahmad MA, et al. Evaluation of the RIPASA Score: a new appendicitis scoring system for the diagnosis of acute appendicitis. Brunei Int Med J. 2010; 6(1):17-26.
Hall EJ, Brenner DJ. Cancer risks from diagnostic radiology: the impact of new epidemiological data. Br J Radiol. 2012;85(1020):e1316-7.
Poletti PA, Platon A, De Perrot T, Sarasin F, Andereggen E, Rutschmann O et al. Acute appendicitis: prospective evaluation of a diagnostic algorithm integrating ultrasound and low-dose CT to reduce the need of standard CT. Eur Radiol. 2011;21(12):2558-66.
Kumar V, Cotran RS, Robbins SL, Appendix In: Robbin's Basic Pathology, 3rd ed, 1992, W.B Saunders, London, 520.
PG Vaughan-Shaw, Rees JR, Bell E, Hamdan M, Platt T. Normal inflammatory markers in appendicitis: evidence from two independent cohort studies. JRSM. 2011;2(5):43.
Kanumba ES, Mabula JB, Rambau P, Chalya PL. Modified Alvarado Scoring System as a diagnostic tool for Acute Appendicitis at Bugando Medical Centre, Mwanza, Tanzania. BMC Surg 2011;11(1):4.
Siddique K, Baruah P, Bhandari S, Mirza S, Harinath G. Diagnostic accuracy of white cell count and C-reactive protein for assessing the severity of paediatric appendicitis. JRSM 2011;2(7):1-6.
National Surgical Research Collaborative. Multicentre observational study of performance variation in provision and outcome of emergency appendicectomy. Br J Surg. 2013;100(9):1240-52.
Chong CF, Thien A, Mackie AJ, Tin AS, Tripathi S, Ahmad MA, et al. Comparison of RIPASA and Alvarado scores for the diagnosis of acute appendicitis. Singapore Medi J. 2011; 52(5):340-5.
Ismail Alnjadat, Baha Abdallah. Alvarado versus RIPASA score in diagnosing acute appendicitis. Rawal Med J. 2013;38(2):147-51.
Nanjundaiah N, Ashfaque Mohammed, Venkatesh Shanbhag, Kalpana Ashfaque, Priya SA. A Comparative Study of RIPASA Score and Alvarado Score in the Diagnosis of Acute Appendicitis. J Clinical Diag Res. 2014; 8(11):3-5.
