European Journal of Molecular & Clinical Medicine

Background: Acute appendicitis is the commonest surgical emergency worldwide and an acceptable negative appendectomy rate is 15-20%.The diagnosis of acute appendicitis is based on signs and symptoms whose interpretation is sometimes subjective (anorexia) and varied (pain perception, referral) and thus the diagnosis of appendicitis has always been a challenge to emergency surgeons. The difficulty in availability of the investigations and the costs incurred are a deterrent factor for most of the emergency units across the world and hence a need for a comprehensive scoring system for the diagnosis of acute appendicitis is the matter of the relevance today. Aim & Objective: To study the diagnostic accuracy of RIPASA score with comparison to ALVARADO score in the diagnosis of acute appendicitis.
Materials and Methods: The study site is Government Medical Colleg, Suryapet Telangana, India.
Results: The Alvarado score, developed in 1986, is based on the points as enumerated by the acronym MANTRELL (each alphabet denoting a parameter assessed) and has been a popular scoring system for use worldwide. The reported literature suggests a sensitivity, specificity in the range of 53 to 88% and 75 to 80% respectively. The RIPASA (Raja Isteri Pengiran Anak Saleha Appendicitis) score was introduced in the year 2009-2010. The reported literature suggests sensitivity of 97.5%, specificity of 81.8%, PPV of 86.5%, NPV of 96.4% and a diagnostic accuracy of 91.8%. In an emergency setting, the on duty Medical Officer can make a quick decision upon seeing the patients with RIF pain by referring those with a RIPASA score ≥ 7.5 to the on-call surgical team for admission, while patients with a RIPASA score < 7.0 can either be observed in the ward or sending home with advice to patient party for observation. Thus RIPASA score is currently a much better diagnostic scoring system for acute appendicitis compared to the Alvarado score, with the former achieving significantly higher sensitivity, NPV and diagnostic accuracy, particularly in Indian population setting.
Conclusion: Further studies need to be done with larger patient population to validate the results obtained in this study. The importance of the RIPASA scores in context with other contemporary scores (e.g. Modified Alvarado with cut off at 6) needs to be evaluated in future