A comparative study of Alvarado and RIPASA scoring systems in diagnosis of acute appendicitis


  • Ankur Varma Department of Surgery, 151 Base Hospital, Guwahati, Assam, India
  • Aditi Varshney Varma Department of Imaging and Radiodiagnosis, 151 Base Hospital, Guwahati, Assam, India
  • Jebin Joseph Department of Surgery, INHS, Sanjeevani, Kochi, Kerala, India




Appendicitis, Alvarado, RIPASA, Dilemma, Clinical score


Background: Acute appendicitis is a diagnostic dilemma for surgeons due to wide array of differential diagnosis and sometimes due to atypical presentation. Diagnosis using sonography, which is the most common modality, has a very low specificity and sensitivity. In such cases it puts a surgeon in dilemma especially in an emergency setting. The integration of clinical scores into the diagnostic process in acute appendicitis has been shown to improve decision making and reducing the negative appendectomy.

Methods: This is a prospective observational study attempted to compare the efficiency of Alvarado and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score, in pre-operative diagnosis of acute appendicitis and to correlate these scores with histo-pathological diagnosis.100 cases satisfying inclusion and exclusion criteria were selected for study. Based on detailed history and thorough clinical examination, diagnosis of acute appendicitis was made.

Results: Sensitivity for detecting acute appendicitis was found to be higher using RIPASA score. Negative appendectomy rate by RIPASA and Alvarado scoring systems were 11.5 and 19.2% meanwhile it was 12% with sonography.

Conclusions: In the diagnosis of acute appendicitis, clinical scoring is a fast, simple, reliable, non-invasive, repeatable and safe diagnostic modality without extra expense and complications. This study shows RIPASA is a better scoring system than Alvarado in the diagnosis of acute appendicitis.

Author Biography

Ankur Varma, Department of Surgery, 151 Base Hospital, Guwahati, Assam, India


Dept of Surgery 


Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132:910-25.

Williams NS, Bulstrode CJK, O'Connell PR. Bailey and Love, Short practice of Surgery. 26th ed. CRC Press; 2013.

Ohmann C, Frante C, Yang Q. Clinical benefit of a diagnostic score for appendicitis. Arch Surg. 1999;134:993-6.

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

Lamparelli MJ, Hoque HM, Pogson CJ, Ball AB. A prospective evaluation of the combined use of the modified Alvarado score with selective laparoscopy in adult females in the management of suspected appendicitis. Ann R Coll Surg Engl. 2000;82(30):192-5.

Shrivastava UK, Gupta A, Sharma D. Evaluation of the Alvarado score in the diagnosis of acute appendicitis. Trop Gastroenterol. 2004;25(4):184-6.

Sadiq M, Amir E. Efficacy of modified Alvarado scoring system in the diagnosis of the acute appendicitis. J Postgrad Med Inst. 2002;16:72-7.

Ohmann C, Yang O, Frank C. Diagnostic score for acute appendicitis. Abdominal pain study group. Eur J Surg. 1995;161:273-81.

Zinner M, Ashley S, Hines J. Maingot’s Abdominal Operations. In: Michael Z, ed. 12th ed. US: Mc Graw Hill Education; 2012.

Fitz RH. Perforating inflammation of the vermiform appendix: With Special reference to its early diagnosis and treatment. Trans Assoc Am Physicians. 1886;1:107.

McBurney C. Experience with early operative interference in cases of disease of the vermiform appendix. NY State Med J. 1889;50:676.

McBurney C. The incision made in the abdominal wall in cases of appendicitis. Ann Surg. 1894;20:38.

Semm K. Endoscopic appendectomy. Endoscopy. 1983;15:59.

Kalan M, Talbot D, Cunliffe WJ, Rich J. Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Surg Engl. 1994;76(6):418-9.

Khan I, Rehman A. Application of Alvarado scoring system in diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad. 2005;17(3):41-4.

Bhattacharjee PK, Chowdhury T, Roy D. Prospective evaluation of modified Alvarado score for diagnosis of acute appendicitis. J Indian Med Assoc. 2002;100(5):310-1.

Malik AA, Wani NA. Continuing diagnostic challenge of acute appendicitis; evaluations through modified Alvarado score. Aust NZ J Surg. 1998;68(7):504-5.

Saidi HS, Chavda SK. Use of a modified Alvarado score in the diagnosis of acute appendicitis. East Afr Med J. 2003;80(8):411-4.

Kumar MS, Kaushik S. Evaluation of modified Alvarado score in decreasing negative appendectomy rate-our experience. IJS. 2000;62(5):342-3.

Talukder DB, Siddiq AKMZ. Modified Alvarado scoring system in the diagnosis of acute appendicitis. JAFMC Bangladesh. 2009;5(1):18-20.

Andersson M, Andersson RE. The appendicitis inflammatory response score: a tool for the diagnosis of acute appendicitis that outperforms the Alvarado score. World J Surg. 2008;32:1843-9.






Original Research Articles