Comparison of modified Alvarado and RIPASA scoring systems correlated with intra-operative findings in predicting acute appendicitis

Madhushankar L., Riya Rai, Anirudh V., A. Vamsi Krishna


Background: Imaging techniques such as ultrasound and CT (computerised tomography) offer to improve clinical outcome by increasing the accuracy of diagnosis. Ultrasound has the great advantage of being radiation free, however it is operator dependant. In comparison, CT can overcome these limitations and greater sensitivity in the diagnosis of acute appendicitis, with reported accuracies of 93-98% but it is expensive and not available at all centre, particularly in countries, like India. Hence we need a scoring system such as MASS (modified Alvarado scoring system) and RIPASA (Raja Isteri Pengiran Anak Saleha appendicitis) scoring system with good sensitivity and specificity. Aim of the present study was to explore the disease on clinical presentation and to compare both scoring systems in diagnosis of acute appendicitis and correlating both the scoring systems with the intra-operative findings.

Methods: This was a prospective study done between October 2019 and October 2020 on hundred patients who underwent appendicectomy at Kempegowda institute of medical sciences and research centre, Bengaluru, Karnataka, India.

Results: In the study among subjects with appendicitis, there was significant association between combined MASS and RIPASA score and intra-operative findings.

Conclusions: In the study combined MASS and RIPASA score with correlated intra-operative findings had diagnostic accuracy in prediction of acute appendicitis.


Acute appendicitis, Modified Alvarado score, RIPASA score

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