Comparative Study of Alvarado and RIPASA Scoring System in Diagnosing Acute Appendicitis

Abstract

Appendectomy is one of the most common surgeries conducted in any hospital. Despite modern advances, the diagnosis of appendicitis remains essentially clinical, requiring a mixture of observation clinical acumen and surgical science and as such it remains an enigmatic challenge and a reminder of the art of surgical diagnosis. A delay in performing an appendectomy runs the risk of appendicular perforation and sepsis, which in turn increases morbidity, hospital stay and mortality. A prospective comparison study was done for RIPASA and Alvarado scoring system by applying them to 150 patients who presented with right iliac fossa pain during the study period. Depending on clinical judgement and other investigations, appendectomy was done. A score of 7.5 is the optimal cut off threshold for RIPASA and 7 for Alvarado scoring system. Sensitivity and specificity of RIPASA scoring system is higher compared to Alvarado scoring system. The difference in ROC curve is 0.135 which is significant between two scoring system (p < 0.001). Unnecessary and expensive radiological investigations can be avoided by using RIPASA score and thus reducing health care expenditure. This present study suggests that RIPASA score can be considered a superior score than the commonly used Alvarado score in terms of higher sensitivity and specificity in diagnosing acute appendicitis. The RIPASA scoring system is a promising and has good sensitivity, specificity and diagnostic accuracy when compared to Alvarado scoring for Asian Population. RIPASA scoring system significantly reduces the number of negative laparotomies without increasing overall rate of appendicular perforation. It can work effectively in routine practice as an adjunct to surgical decision making in questionable acute appendicitis. It is simple to use and easy to apply since it relies only on history, clinical examination and basic lab investigations. It is cost-effective and can be used in all district general hospitals with basic lab facilities.