A Comparative Study of RIPASA Score and Modified Alvarado Score in Acute Appendicitis in Nepalese Population

Abstract

Appendicitis is one of the most common reasons for emergency laparotomy, with a nearly 7% lifetime cumulative incidence. 1 It is the most common acute surgical problem of the abdomen, and appendectomy is the fifth most common surgical procedure performed on the gastrointestinal tract. 2 There have been numerous advances in the diagnosis and treatment of appendicitis. Nonetheless, acute appendicitis continues to challenge surgeons to this day. Diagnostic errors are common, resulting in a median incidence of perforation of 20% and a negative laparotomy rate ranging from 2% to 30%. 3 The rate of complications was 2.5% in the negative group compared with a rate of 1.8% in the appendicitis group, and the fatality rate was 1.5% in the negative appendectomy group compared with 0.2% for those with appendicitis. So it is opined that negative appendectomy is to be avoided when possible, due to the risk of surgical complications and the cost associated with unnecessary surgery. 4Various scoring systems have been devised to aid the clinician in the accurate diagnosis of acute appendicitis. Classic Alvarado score 5 included a shift to the left of neutrophil maturation (score Results: A negative appendectomy rate of 11.67 % was observed (9.64 % for males and 16.22 % for females). Complicated appendicitis was found in 27.36% of patients. Modified Alvarado score had a sensitivity of 61.32 % and specificity of 71.43 % at a cut of value of 7. At cut off of > 7.5 for acute appendicitis, RIPASA score had a sensitivity of 97.17% and specificity of 57.14%. Accuracy of MAS was 62.5% while it was 92.5% for RIPASA score.Conclusions: RIPASA score demonstrated higher sensitivity and accuracy but lower specificity compared to the modified Alvarado score in our study group. More studies with larger sample size need to be carried out for further validation of this new score.