Evaluation of RIPASA versus modified ALVARADO score in the diagnosis of acute appendicitis

Meera Kumari ¹, Ajay Kumar Jha¹, Bipin Kumar Singh², Rupesh Keshri ³, Pallavi Suman⁴, Sandip Kumar Rahul ³

Author Affiliation

¹Department of General Surgery, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India

²Dept. of General Surgery, MARC Hospital, Katihar, Bihar, India
³Department of Paediatric Surgery, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
⁴Department of Anaesthesiology, Bhagwan Mahavir Institute of Medical Sciences, Pavapuri, Bihar, India

Abstract

Background: The diagnosis of Acute Appendicitis is mostly clinical through different scores; comparative assessment of Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score against modified ALVARADO score for the diagnosis of Acute Appendicitis would reveal the better score for clinical use.

Objective: Evaluation of RIPASA score against modified ALVARADO score as a diagnostic score for Acute Appendicitis.

Materials and Methods: A prospective study was conducted on all cases of suspected Appendicitis at a tertiary center from January 2021 to June 2022. Each patient was scored by both RIPASA and modified ALVARADO scores and Histopathological report for Appendicitis was taken as the gold standard. Both the scores were evaluated for their diagnostic ability.

Results: 80 patients with suspected Acute Appendicitis with a mean age of 21.36 years and with female predominance were scored by both RIPASA and modified ALVARADO scores. Sensitivity, specificity, Positive and Negative predictive values, Positive and Negative likelihood ratio, and area under ROC curve for RIPASA score (at 7.5 cutoff) were 94.74, 82.61, 93.10, 86.36, 5.45, 0.06 and 0.93; corresponding values for modified ALVARADO score (at 7.0 cutoff) were 59.65, 82.61, 89.47, 45.24, 3.43, 0.49 and 0.89 respectively. Both the scores had positive correlation when diagnosing an Acute appendicitis patient.

Conclusion: RIPASA Score (at 7.5 cut-off) is a better diagnostic tool than modified ALVARADO Score (at 7 cut-off) due to better sensitivity, Positive and Negative predictive values, and higher area under the fitted ROC curve.

DOI: 10.63475/j.yjom.2024.023

Keywords: Acute Appendicitis, Modified ALVARADO score, RIPASA score

Pages: 218-224

View: 19

Download: 29

DOI URL: http://doi.org/10.63475/j.yjom.2024.023

Publish Date: 15-12-2024

Full Text

Despite its high prevalence, diagnosing acute appendicitis is a challenge because it is mainly based on presenting symptoms, physical examination findings and basic laboratory investigations all of which raise a high index of suspicion but often are not diagnostic individually.1 Chronic medication use in the elderly and changes in pain tolerance with age may lead to differences in physical examination findings and blood parameters between age groups, and the differences in diagnostic parameters, making the diagnosis of acute appendicitis more difficult.2 It has been estimated that the diagnosis of Acute Appendicitis is missed at a rate of 3.8-15% for children and 5.9-23.5% for adults during management in Emergency Department.3 Although medical diagnostic tools and imaging technology has developed tremendously, yet the diagnosis of Acute Appendicitis is 

often missed. So, the clinical examination results in a suspicious patient are still depended upon and because not one symptom or sign helps us conclusively diagnose Acute Appendicitis, we depend on several scoring systems which have been suggested to have a role in diagnosing Appendicitis.

Alvarado (MANTRELS) scoring system was first described in 1986 and has been the most popular scoring system to diagnose Acute Appendicitis.4 The original Alvarado score describes a possible total of 10 points, but those medical facilities that are unable to perform a differential white blood cell count, are using a Modified Alvarado Score with a total of 9 points.5 Several other scoring systems were subsequently reported like Pediatric Appendicitis score, Tzanaki score, Lintula score, Eskelinen score, Ohmann score, Fenyo-Lindberg score, Christian score, Adult Appendicitis score, AIR score, Nigam Score and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scores.6–12 Different investigators have shown advantages of using a particular scoring system over the other in their work. The RIPASA scoring system has been reported to have better sensitivity and specificity for Asian and middle-eastern population.6,7 We have been using the Alvarado scores for the diagnosis of Acute Appendicitis for a long time but had a significant number of negative appendicectomies and missed a few appendicitis cases which got complicated later. So, a prospective study was conducted at our center to compare the scores of Alvarado andRIPASAin patientssuspected tohaveacute appendicitis and were compared against the positive biopsy report of Acute Appendicitis taken as the gold standard.

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