Comparative Study between RIPASA and Modified Alvarado Scoring System in the Diagnosis of Acute Appendicitis
Journal of Evolution of Medical and Dental Sciences
A B S T R A C T BACKGROUND Acute appendicitis is one of the common surgical emergencies. Acute appendicitis can be converted to complicated appendicitis such as gangrenous appendicitis or perforated appendix, which is associated with greater mortality and morbidity. Therefore, surgeons have been forced to operate the patient when the diagnosis is in question. The accuracy of the clinical examination varies greatly depending on the experience of the examiner. Surgeons have traditionally accepted
... ditionally accepted negative findings of appendectomy and the removal of a normal appendix. There are many scoring systems developed such as Alvarado and Modified Alvarado scoring system. RIPASA, a new scoring system has been developed to help in the diagnosis of acute appendicitis in Asian countries. In our study, we have compared the Modified Alvarado and RIPASA scoring system for their sensitivity, specificity and diagnostic accuracy. METHODS This observational study was done in Sri Siddhartha Medical College and Research Institute between October 2018 and March 2020 among 70 patients with clinical diagnosis of acute appendicitis and undergoing appendectomy, after obtaining their consent. Both Modified Alvarado and RIPASA score were calculated for all the patients. The operative findings and postoperative histopathology report were compared with the two scoring systems. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated. RESULTS At optimal cut-off point of 7.5 for RIPASA, the sensitivity and specificity were 94.1 % and 33.3 % respectively. At the cut-off threshold of 7.0 for modified Alvarado score, the sensitivity and specificity is 30.9 % and 6.0 % respectively. The diagnostic accuracy of RIPASA was 63.31 % which is better than Modified Alvarado score. CONCLUSIONS Both Modified Alvarado and RIPASA score have significant differences in sensitivity, specificity and diagnostic accuracy in the diagnosis of acute appendicitis. In the present study RIPASA score was found to be more accurate in detecting cases of acute appendicitis when compared to the Modified Alvarado scoring system. Use of scoring systems in developing countries would be useful in detecting acute appendicitis quickly and in further preventing progression of disease and its complication.