Abstract

Background: Acute appendicitis is the most common cause of abdominal emergency in
both developed and developing countries, yet its diagnosis remains challenging. Several
scoring systems have been developed in order to aid the decision-making process to
reach diagnosis of acute appendicitis in the quickest way, which include the Alvarado
Score, the AIRS Score, and the RIPASA Score. The current study compares and
assesses the utility of the scoring systems in establishing a diagnosis of acute
appendicitis, as compared to a final histological report.
Materials and Methods: This was a prospective study conducted at the Department of
General Surgery, Rajindra Hospital, Patiala, including 60 patients presenting with right
iliac fossa pain for less than 72 hours and were planned to undergo appendectomy, from
2020 to 2021. A structured pre-prepared proforma was used to enter the complete
history, clinical examinations, hematological and biochemical investigations, the
calculated scores for the Alvarado, RIPASA, and AIRS scoring system, and the
histopathological report for each patient. Sensitivity, specificity, accuracy, PPV, and
NPV were calculated for Alvarado, RIPASA, and AIRS Scores for the diagnosis of
acute appendicitis with histopathologic diagnosis as the gold standard. Receiver
operator characteristics (ROC) curve was done, and criterion value was estimated
depending on the specificity and sensitivity.
Results: In our series, the RIPASA score had the highest statistical parameters amongst
all 3 scores. The sensitivity, specificity, PPV and NPV were 92.45%, 85.71%, 98%, and
60% respectively. It had the highest diagnostic accuracy (91.67%). It was followed by
the AIRS scoring system with a sensitivity, specificity, PPV, and NPV of 88.68%,
71.43%, 95.92%, and 45.45% respectively. Its diagnostic accuracy was 86.67%. The
Alvarado score had a sensitivity, specificity, PPV, and NPV were 81.13%, 71.43%,
95.56%, and 33.33% respectively. Its diagnostic accuracy was 80%.
Conclusion: It is concluded that the RIPASA Scoring system is a valid and better tool
with high discriminating power in the diagnosis of acute appendicitis, and for
minimizing unproductive admission and abdominal explorations, especially in Asian
ethnicity, as it outperforms the Alvarado and the AIRS Scores in all statistical
parameters, as per our study.