A Comparative Study of Ripasa Score and Modified Alvardo Score in the Diagnosis of Acute Appendicitis

Abstract

Acute appendicitis is one of the most common surgical emergencies in clinical practice, with an estimated lifetime prevalence of approximately 1 in 7. Different techniques have been devised to assist in equivocal cases in attempts to decrease negative appendicectomy rates. Except USG and CT as a principal imaging technique for appendicitis, several clinical systems have been developed to aid in the diagnosis of acute appendicitis. Several scoring systems exist specifically for appendicitis are the Alvarado score, the Modified Alvarado score, the Samuel score, Kharbanda's Low Risk score, the Lindberg score, the Ohmann score, the RIPASA score etc. here the present study has been attempted to assess the reliability and practical applicability of the widely used Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system and comparison of the RIPASA and the modified Alvarado scoring system in the diagnosis of acute appendicitis among patients attending North Bengal Medical College and Hospital, West Bengal, India. Total 98 patients including males and females undergoing emergency appendicectomy in Department of General Surgey, North Bengal Medical College were considered for present study. Depending on the clinical details and investigation, RIPASA scoring system and Modified Alvarado Score System has been administered with corroboration of Histopathological report. Sensitivity, specificity, positive predictive value (PPV) and negative predictive (NPV) for RIPASA & Alvarado system was done. The RIPASA scoring system in the present study had sensitivity of 96.29, specificity 76.4, positive predictive value 95.1, negative predictive value 81.25% and diagnostic accuracy 92.85% whereas Modified Alvarado score had sensitivity of 76.82%, specificity of 88.23%, positive predictive value of 96.92%, negative predictive value of 45.45%, and diagnostic accuracy of 81.25%.The present study revealed that RIPASA scoring system is more convenient, accurate, and specific scoring system for Indian population than Alvarado scoring system.

A comparative study of RIPASA score and modified Alvarado score in diagnosis of acute appendicitis

“…The PPV was 95.41% and the NPV was 12.5%Muduli et al, reported that at the optimal cut-off threshold score of 7.5 for the RIPASA score, the calculated sensitivity and specificity were 97.26% and 75% respectively compared with 68.49% and 84.37% respectively for Alvarado score at an optimal cut-off threshold of 7 16. While Brman et al, in his study reported that the RIPASA scoring system had sensitivity of 96.29, specificity 76.4, positive predictive value 95.1, negative predictive value 81.25% and diagnostic accuracy 92.85% whereas Modified Alvarado score had sensitivity of 76.82%, specificity of 88.23%, positive predictive value of 96.92%, negative predictive value of 45.45%, and diagnostic accuracy of 81.25% 17.…”