Can RIPASA Scoring System Predict the Pathological Stage of Acute Appendicitis?

Abstract

Introduction. Being one of the scoring systems used in the diagnosis of acute appendicitis, the RIPASA score can be used easily with a high diagnostic accuracy. Objective. To evaluate the possible relationship between RIPASA scores and the histopathological examination results of appendectomy materials. Materials and Methods. This study retrospectively reviews 242 patients who were operated in our clinic between January 2016 and January 2018 with a prediagnosis of acute appendicitis, and the RIPASA scores calculated in the preoperative period were compared to the histopathological examination results of the appendectomy specimens. Results. The patients consisted of 124 (51.2%) females and 118 (48.8%) males. The ages of the patients ranged from 15 to 81 years. The patients were divided into 3 groups based on their RIPASA scores as low-score (4-7), intermediate-score (7.5-11.5), and high-score (12 and over) groups. There were 20 (52.6%) catarrhal-stage appendicitis cases and 17 (44.7%) normal appendixes in the low-score group; there were 70 (83.3%) catarrhal-stage appendicitis cases, 9 (10.7%) suppurative-stage appendicitis cases, 4 (4.8%) gangrenous-stage appendicitis cases, and 1 (1.2%) perforated appendicitis case in the intermediate-score group. In the high-score group, there were 53 (44.2%) suppurative-stage appendicitis cases, 51 (42.5%) gangrenous-stage appendicitis cases, 11 (9.2%) perforated appendicitis cases, and 5 (4.2%) catarrhal-stage appendicitis cases. A strong positive correlation was found between the RIPASA scores of the patients and the pathological stage of appendicitis (r=0.889; p<0.001). Conclusion. The RIPASA scoring system can make a correct and prompt diagnosis of acute appendicitis including its possible pathological stage without any need for a computed tomography.

Predictive Value of Alvarado, Acute Inflammatory Response, Tzanakis and RIPASA Scores in the Diagnosis of Acute Appendicitis

“…The newer RIPASA score includes 18 clinical and laboratory parameters, has greater sensitivity and specificity than the Alvarado score, especially in the Asian population [11,24]. In this study, 92% of patients had a score higher than 8.…”

“…The ROC analysis for the prevention of delayed RIPASA appendectomy has shown to have sufficient discriminatory ability (AUC of 0.65), with a sensitivity of 62.5% and a specificity of 63.5%. There are publications in the literature with high specificity and sensitivity; such are the studies of Chong et al and of Chee Fui Chong [11,[24][25][26].…”

The effectiveness of the Raja Isteri Pengiran Anak Saleha Appendicitis Score in the diagnosis of acute appendicitis in elderly patients

“…Acute appendicitis risk is lower in those with a score of less than 7, while the risk is relatively higher in those with a score of 7.5 and above [7,18]. The RIPASA score, used especially in the Asian population, is an inexpensive, easy-to-use, and highly reliable quantitative scoring system that enables accurate and early diagnosis of acute appendicitis while significantly reducing the rate of negative appendicitis [19]. In a study conducted by Malik et al, it was shown that patients who were treated by surgical resection for acute appendicitis in a western population with a RIPASA score over 7.5 showed a sensitivity, specificity, positive predictive value rate, negative predictive value rate, and diagnostic accuracy of 85.39%, 69.86%, 84.06%, 72.86%, and 80%, respectively [20].…”

“…In a study conducted by Malik et al, it was shown that patients who were treated by surgical resection for acute appendicitis in a western population with a RIPASA score over 7.5 showed a sensitivity, specificity, positive predictive value rate, negative predictive value rate, and diagnostic accuracy of 85.39%, 69.86%, 84.06%, 72.86%, and 80%, respectively [20]. In a study conducted by Karapolat et al, it was shown that the RIPASA score obtained using simple clinical and laboratory data can be used to accurately and quickly diagnose acute appendicitis along with its possible pathological stage without the need for computed tomography [19]. In our study, when the RIPASA score in the elderly was compared with the histopathological data, its sensitivity was 86.2%, its specificity was 40%, while its positive predictive value, negative predictive value, and diagnostic accuracy rate were detected to be 89.3%, 33.3%, and 79.4%, respectively.…”

Comparison of the RIPASA and Labeda Scoring Systems to Assess the Morphological Severity of Acute Appendicitis

“…For RIPASA scoring, 7.5 was used as the indicated surgical threshold. A RIPASA score of 12 was judged to be very high (severely acute appendicitis), while scores of 7.5-11.5 indicated a high probability of acute appendicitis, 5.0-7.0 indicated a low probability, and 5.0 indicated that acute appendicitis was not diagnosed [10], [11]. For Labeda scoring, a score of >10 suggested that emergency surgery was required, while scores between 10 and 57 indicated that patients should be observed for 2-3 h before making further decisions based on changes in the score.…”