Comparison of Ripasa and Alvarado Scoring System in Acute Appendicitis- A Descriptive Study

Abstract

BACKGROUND Acute appendicitis is the most common cause of an acute abdomen requiring surgery with a lifetime risk of about 7%. Even with recent advances in imaging modalities, considerable morbidity continues to be associated with appendicitis. Diagnostic delay leads to perforation and other complications increasing the morbidity. Scoring systems were introduced to reduce the rate of negati ve appendicectomy. Alvarado designed a 10-point clinical scoring system, where a score of ≥ 7 warrants appendicectomy. Recently, RIPASA scoring system was implemented to overcome the problems with Alvarado scoring system based on 14 fixed clinical parameters, where a score of ≥ 7.5 warrants a surgical intervention.Our study compares the Alvarado and RIPASA scoring system in diagnosing acute appendicitis and correlate with histopathological findings. MATERIALS AND METHODSThe descriptive study with patients who presented to our Emergency/ General Surgery Department from January 2016 to October 2016 with right iliac fossa pain and who were suspected of acute appendicitis were considered for the study. Of them, hundred patients who satisfied our inclusion criteria were enrolled in our study. A detailed history, clinical examination and laboratory investigations were done for all. Scores were obtained for all the patients using both the Alvarado and RIPASA scoring systems. All the patients underwent appendicectomy. Histopathological diagnosis was considered as gold standard. Sensitivity, specificity, positive predictive value and negative predictive value for both these scorings were calculated and analysed comparatively with a Chi-square test. RESULTSOut of 100 patients, 57 were male and 43 were female. Both the scoring system were obtained and correlated with histopathological findings. As per Alvarado scoring, 58 patients had a score of ≥ 7 and 42 patients had a score of < 7. On applying the RIPASA scoring system, 73 patients had a score of ≥ 7.5 and 27 patients had a score of < 7.5. The specimens of all the hundred patients were examined, of which 74 showed features of acute appendicitis histopathologically. The sensitivity of Alvarado and RIPASA was 68.92% and 91.89% respectively. The diagnostic accuracy was 70% by Alvarado compared to 89% by RIPASA. The negative appendectomy rate by Alvarado scoring was 12.06% and 6.85% by RIPASA. CONCLUSIONOur study concluded that RIPASA score is a simple and rapid system with higher sensitivity compared to the Alvarado score. The NPV (Negative Predictive Value) and diagnostic accuracy was also higher with RIPASA scoring system in our study population. Hence, RIPASA scoring system is better than Alvarado scoring system in establishing the diagnosis of acute appendicitis. KEYWORDSAcute Appendicitis -Alvarado Scoring System -RIPASA Scoring System. HOW TO CITE THIS ARTICLE: Ansari TS, Kumar VS. Comparison of RIPASA and Alvarado scoring system in acute appendicitis-a descriptive study.