A comparative study on RIPASA and modified Alvarado score in the diagnosis of acute appendicitis in tertiary care hospital
Keywords:Accuracy, Acute appendicitis, Alvarado score, Modified, RIPASA score, Sensitivity
Background: Acute Appendicitis is common surgical emergencies with a lifetime prevalence of approximately 1 in 7. Despite advances in diagnosis and treatment; acute Appendicitis is still associated with morbidity (10%) and mortality (1-5 %). Presentations of acute Appendicitis can mimic various acute medical and surgical conditions, and the diagnosis is predominantly a clinical one-different scoring systems used for aiding in early diagnosis of Acute Appendicitis and its prompt management. Alvarado score and RIPASA score are the most popular ones. So we retrospectively applied and compared Alvarado and RIPASA score in the diagnosis of acute Appendicitis in Indian population.
Methods: In this study, we compared RIPASA score and Alvarado scoring system retrospectively by applying to 74 patients. This study period from November 2018 to March 2020. Both scores were calculated for patients presented with right iliac fossa pain. Sensitivity, specificity, positive predictive value (PPV), negative predictive (NPV), diagnostic accuracy for RIPASA and Alvarado system was calculated.
Results: The sensitivity and specificity of the Alvarado score were 85.07% and 57.14% respectively. The sensitivity & specificity of RIPASA score were 91.04% and 71.42% respectively. Accuracy of the Alvarado scoring system is 82.44% and for RIPASA scoring system is 89.18%. The results show that the RIPASA scoring system is a better diagnostic tool for the diagnosis of Acute Appendicitis.
Conclusions: RIPASA scoring system is simple, accurate, convenient, and more specific scoring system than the modified Alvarado scoring system for the Indian population.
Prystowsky JB, Pugh CM, Nagle AP. Current problems in surgery. Appendicitis Curr Probl Surg. 2005;42(10):688-742.
Howell JM, Eddy OL, Lukens TW, Thiessen ME, Weingart SD, Decker WW. Clinical policy: Critical issues in the evaluation and management of emergency department patients with suspected Appendicitis. Ann Emerg Med. 2010;55:71-116.
Karami MY, Niakan H, Zadebagheri N, Mardani P, Shayan Z, Deilami I. Which one is better? Comparison of the acute inflammatory response, raja isteri pengiran anak saleha appendicitis and alvarado scoring systems, Annals of Coloproctology. 2017;3(6):227-31.
Chong CF, Adi MIW, Thien A. Development of the RIPASA score: A new appendicitis scoring system for the diagnosis of acute appendicitis. Singapore Med J. 2010;51(3):220-5.
Do-Nascimento RR, Souza JCG, Alexandre VB, Kock KS, and Kestering DM, Association between the Alvarado score and surgical and histopathological findings in acute Appendicitis. Revista do Col´egio Brasileiro de Cirurgioes. 2018;45(5):1901.
Sousa-Rodrigues CF, Rocha AC, Rodrigues AK, Barbosa FT, Ramos FW, Valoes SH. Correlation between the Alvarado Scale and the macroscopic aspect of the appendix in patients with Appendicitis. Revista do Col´egio Brasileiro de Cirurgi˜oes. 2014;41(5):336-9.
Gupta M, Virdi VS, Agnihotri L, Mandial V. Evaluation of modified Alvarado score and ultrasonography for the diagnosis of acute appendicitis. IJSR. 2016;5(3):2166-8.
Antel J, Rivera L, Landenberg B, Halm G, Fatava MA. Brown CVR Clinical diagnostic pathway for acute Appendicitis: prospective Validation JAM Coll Surg. 2006;203(6):849-56.
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 Med J. 2011;52(5):340-5
Alnjadat I, Abdallah B. Alvarado versus RIPASA score in diagnosing acute Appendicitis. Rawal Med J. 2013;38(2):147-51.
Reyes-Garcia, Zaldiver-Ramirez FR, Creuz-Martinez R, Sandoval Martinez MD, Gutierrez- Banda CA, Athie Gutierrez C. diagnostic accuracy of the RIPASA score for the diagnosis of acute Appendicitis: Comparative analysis with the Modified Alvarado score. Cir Gen. 2012;34(2):101-6.
Gunes TI, Yilmaz KB, Sahin A, Aydin H, Akinci M, Hekimoglu B. Evaluation of clinical Alvarado scoring system and CT criteria in the diagnosis of acute Appendicitis, Radiology Research and Practice. 2016;6:9739385.
Erdem H, Çetinkunar S, Daş K, Alvarado, Eskelinen, Ohhmann, Raja Isteri Pengiran Anak Saleha Appendicitis scores for diagnosis of acute appendicitis. World J Gastroenterol. 2013;19(47):9057-62.
Tinaikar A, Naik V; An observational comparative study between RIPASA and modified Alvarado scoring in the diagnosis of acute appendicitis 2019.