One of the commonest clinical presentation that requires emergency surgery is acute appendicitis. Much efforts have been directed towards early diagnosis and intervention. Delay in diagnosis leads to increase morbidity and costs. In present study, we aimed to compared two scores i.e. RIPASA and Alvarado scoring system in the diagnosis of acute appendicitis.
Materials and methods: Present hospital based screening included 100 patients presenting with Right iliac fossa pain and clinically diagnosed as acute appendicitis. The diagnosis of acute appendicitis was confirmed by operative findings and histopathological assessment of the appendicectomy specimen. A score of 7 or above is taken as high probability of acute appendicitis for Alvarado scoring system while a score of 7.5 or above was taken as high probability of acute appendicitis for RIPASA scoring system.
Results:Sensitivity and specificity of modified Alvarado score in diagnosing Appendicitis was 58.7% and 88% while PPV and NPV was 93.6% and 41.5%. Sensitivity and specificity of RIPASA score in diagnosing Appendicitis was 89.3% and 84% while PPV and NPV was 94.4% and 72.4%. Overall diagnostic accuracy was 88% and 66% for RIPASA and modified Alvarado Score. Both scores showed good efficacy in screening the cases appendicitis on ROC analysis. However, overall screening efficacy of RIPASA score was better than Modified Alvarado Score (AUC – 0.891 vs 0.702).
Conclusion:RIPASA score is currently a much better diagnostic scoring system for acute appendicitis compared to the Alvarado score. RIPASA had significantly higher sensitivity, NPV and diagnostic accuracy in our study group. The 14 fixed parameters can be easily and rapidly obtained in any population setting by taking a complete history and conducting a clinical examination and two simple investigations. In remote settings or emergency, a quick decision can be made with regards to referral to an operating surgeon or observation. The use of RIPASA scoring would help in decreasing the unwarranted patient admissions and also expensive radiological investigations.