Comparison of RIPASA and ALVARADO scores for risk assessment of acute appendicitis: A systematic review and meta-analysis

Abstract

Background In the last decades, several clinical scores have been developed and currently used to improve the diagnosis and risk management of patients with suspected acute appendicitis (AA). However, some of them exhibited different values of sensitivity and specificity. We conducted a systematic review and metanalysis of epidemiological studies, which compared RIPASA and Alvarado scores for the diagnosis of AA. Methods This systematic review was conducted using PubMed and Web of Science databases. Selected studies had to compare RIPASA and Alvarado scores on patients with suspected AA and reported diagnostic parameters. Summary estimates of sensitivity and specificity were calculated by the Hierarchical Summary Receiver Operating Curve (HSROC) using STATA 17 (STATA Corp, College Station, TX) and MetaDiSc (version 1.4) software. Results We included a total of 33 articles, reporting data from 35 studies. For the Alvarado score, the Hierarchical Summary Receiver Operating Curve (HSROC) model produced a summary sensitivity of 0.72 (95%CI = 0.66–0.77), and a summary specificity of 0.77 (95%CI = 0.70–0.82). For the RIPASA score, the HSROC model produced a summary sensitivity of 0.95 (95%CI = 0.92–0.97), and a summary specificity of 0.71 (95%CI = 0.60–0.80). Conclusion RIPASA score has higher sensitivity, but low specificity compared to Alvarado score. Since these scoring systems showed different sensitivity and specificity parameters, it is still necessary to develop novel scores for the risk assessment of patients with suspected AA.

RIPASA Score in Diagnosis of Acute Appendicitis: To What Extent Is It Accurate?

“…Complications related to AA have a bad impact on the patient's prognosis. This is why the need of an accurate prediction scoring system is crucial [13] . The use of clinical scoring systems will have a good helping tool for healthcare providers for accurate diagnosis of AA [12] .…”

The role of blood inflammatory markers in the preoperative diagnosis of acute appendicitis

“…The Ripasa is one of the more recently developed scoring systems 5 . The Alvarado score uses leukocytosis >10 000 with left shift (neutrophils >75%), while the Ripasa score uses only leukocytosis 6 …”

“…5 The Alvarado score uses leukocytosis >10 000 with left shift (neutrophils >75%), while the Ripasa score uses only leukocytosis. 6 In our Medical Center we use (sporadically) Ripasa score.…”