A comparative study of RIPASA score and modified Alvarado score in diagnosis of acute appendicitis
Keywords:Acute appendicitis, Alvarado score, Comparison, Diagnostic accuracy, RIPASA score
Background: Various diagnostic criteria have been described for diagnosing acute appendicitis. Of these, Alvarado score has been the most commonly used. The RIPASA score is a new diagnostic scoring system developed for the diagnosis of acute appendicitis and showed higher sensitivity, specificity and diagnostic accuracy as compared to Alvarado score. we want to compare prospectively Alvarado and RIPASA score by applying them to patients attending emergency department complaining of right iliac fossa pain that could probably be acute appendicitis.
Methods: Patients with clinically suspected acute appendicitis were classified according to both Alvarado and RIPASA scoring systems before undergoing surgery. Histopathological examination of the removed appendix was taken as the gold standard for diagnosis of acute appendicitis.
Results: Among (90%) patients had histologically confirmed appendicitis. With the cut-off value greater than 7.5 for RIPASA score; sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy were 88.2%, 14.5%, 73.1%, 32%,and 68% respectively. With the cut-off value greater than 7 for Alvarado score, sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy rates were 51.2%, 80 %, 91 %, 29%, and 57%, respectively. 87.5% of patients were correctly stratified by RIPASA under higher probability group while only 45% were classified by Alvarado as high probability.
Conclusions: RIPASA scoring system showed high sensitivity and diagnostic accuracy in comparison to Alvarado scoring system. So, it can be applied for the diagnosis of acute appendicitis.
Stephens PL, Mazzucco JJ. Comparison of ultrasound and the Alvarado score for the diagnosis of acute appendicitis. Conn Medi. 1999;63(3):137-40.
Krajewski S, Brown J, Phang PT, Raval M, Brown CJ. Impact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: a meta-analysis. Can J Surg. 2011;54(1):43.
Ozao-Choy J, Kim U, Vieux U, Menes TS. Incidental findings on computed tomography scans for acute appendicitis: prevalence, costs, and outcome. Am Surg. 2011;77(11):1502-9.
Alvarado A. A practical score for the early diagnosis of acute appendicitis. Annal Emerge Medi. 1986;15(5):557-64.
Al-Hashemy AM, Seleem MI. Appraisal of the modified Alvarado score for acute appendicitis in adults. Saudi Med J. 2004;25(9):1229-31.
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. Sin Medi J. 2010;51(3):220.
Williams GR. Presidential Address: a history of appendicitis. With anecdotes illustrating its importance. Annal Surg. 1983;197(5):495.
Flum DR, Morris A, Koepsell T, Dellinger EP. Has misdiagnosis of appendicitis decreased over time?: a population-based analysis. JAMA. 2001;286(14):1748-53.
Nanjundaiah N, Mohammed A, Shanbhag V, Ashfaque K, Priya SA. A Comparitive Study of Alvarado Score And Ripasa Score in the diagn of acute appendicitis. J Clin Diagn Res. 2014;8(11):3-5.
Khan I, ur Rehman A. Application of Alvarado scoring system in diagnosis of acute appendicitis. J Ayub Medi Col Abbott. 2005;17(3).
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. Sing Medi J. 2011;52(5):340-5.
Jang SO, Kim BS, Moon DJ. Application of Alvarado score in patients with suspected appendicitis. Kor J Gastroenterol= Taehan Sohwagi Hakhoe chi. 2008;52(1):27-31.
Baral S, Thapa N, Chhetri RK, Sharma R. A Comparative Analysis Between RIPASA and Alvarado Scoring Systems for the Diagnosis of Acute Appendicitis-A Nepalese Perspective. J Lum Medi Col. 2018;6(2):5.
Pasumarthi V, Madhu CP. A comparative study of RIPASA score and ALVARADO score in diagnosis of acute appendicitis. Int Surg J. 2018;5(3):796-801.
Timilsina BR, Shah R, KC SR, Upadhyay HP, Lamsal S, Belbase N, et al. RIPASA vs Modified Alvarado Scoring System for diagnosis of Appendicitis. J Col Medi Sci-Nepal. 2018;14(4):213-6.
Muduli IC, Rout BK, Mallick SN. Comparison of ripasa and alvarado score in diagnosis of acute appendicitis. Methods. 2015.
Barman MK, Mukherjee K, Das K. A Comparative Study of Ripasa Score and Modified Alvardo Score in the Diagnosis of Acute Appendicitis. JMSCR. 2019;7(7):148-53.
Regar MK, Choudhary GS, Nogia C, Pipal DK, Agrawal A, Srivastava H. Comparison of Alvarado and RIPASA scoring systems in diagnosis of acute appendicitis and correlation with intraoperative and histopathological findings. Int Surg J. 2017;4(5):1755-6.