Isteri Pengiran Anak Saleha Appendicitis Research Articles

Reliability of Diagnosis of Acute Appendicitis by Clinical Assessment Through Modified ALVARADO Vs RIPASA Scoring System at Combined Military Hospital, Rawalpindi

Objective: To determine the diagnostic accuracy of RIPASA (Raja Isteri Pengiran Anak Saleha Appendicitis) andModified ALVARADO score in the diagnosis of acute appendicitis by using histopathology as a gold standard.Study Design: A comparative cross-sectional study.Place and Duration of Study: The study was carried out at the Department of Surgery, Combined MilitaryHospital (CMH) Rawalpindi, Pakistan from January 2020 to August 2020.Methods: A total of 126 patients suspected of having acute appendicitis were included. All patients who hadmet the inclusion criteria were chosen via the process of consecutive sampling. Patients who had presentedwith right iliac fossa pain, migration of pain, anorexia, nausea, and vomiting and were admitted to the hospitalwere assessed prospectively using RIPASA and Modified ALVARADO scores. RIPASA (Raja Isteri Pengiran AnakSaleha Appendicitis) score > 7.5 and Modified ALVARADO score > 7 were used to diagnose acute appendicitis.The diagnosis was confirmed postoperatively using a histopathological report. Every scoring system wasassessed for validity by calculating sensitivity, specificity, diagnostic accuracy, negative predictive value, andpositive predictive value.Result: The results obtained from individuals recruited in the study showthat out of 126 patients, 70(55.6%)were male and 56(44.4%) were female. The mean age was 33.25±8.19 years. 83.3% of patients having RIPASA(Raja Isteri Pengiran Anak Saleha Appendicitis) score (≥7.5) and 68.3% of patients having Modified ALVARADOscore (≥7) have met the criteria for acute appendicitis. The sensitivity and specificity of the RIPASA (Raja IsteriPengiran Anak Saleha Appendicitis) score were 90.9% and 73.3% compared with 73.8% and 73.3% of theModified Alvarado score.Conclusion: The RIPASA (Raja Isteri Pengiran Anak Saleha Appendicitis) scoring system is a more convenient,accurate, and specific scoring system for our population than the Modified ALVARADO scoring system. How to cite this: Qamar R, Mahmood K, Javed R, Sher F, Tufail I.Reliability of Diagnosis of Acute Appendicitis by Clinical Assessment Through Modified Alvarado Vs Ripasa Scoring System. Life and Science.2024; 5(2): 193-198. doi: http://doi.org/10.37185/LnS.1.1.346

Association Between Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) Scoring and Pathological Severity of Acute Appendicitis: A Cross-Sectional Study.

Background and objectives Appendicitis is a frequent cause of abdominal pain. Because of the limited availability of imaging services in many medical centers and an urge to reduce the substantial number of unnecessary appendectomies, several clinical diagnostic tools have been constructed.A novel diagnostic tool, referred to as the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score, has been created to assist in identifying acute appendicitis (AA) in Asian nations. The study aimed to assess the correlation between RIPASA scores and the severity of appendicitis as determined by pathological examination. Materials and methods The study was a prospective observational investigation undertaken in the Department of General Surgery at Muslim education society (MES) Medical College Perinthalmanna over12 months. The study included all patients who had been diagnosed with AA and underwent appendectomy, provided they satisfied both the inclusion and exclusion criteria. An analysis was conducted on a convenience sample of 225 individuals using a prestructured proforma. The RIPASA scores were estimated before their surgery, taking into account their age, gender, symptoms, physical examination findings, and laboratory findings. These scores were subsequently contrasted withthe histopathological results obtained after the appendectomy. The individuals were categorized into three groups according to their RIPASA scores. The lower-score category, scores between 4 and 7. The intermediate-score category consists of scores ranging from 7.5 to 11.5, while the higher-score category includes scores of 12 and above. These scores are correlated with the histopathology report (HPR) to determine the presence of appendicitis, perforated appendix, appendicular abscess, or the absence of pathology observed. Results The study population comprised of 137 (60.9%) males and 88 (39.1%) females. Among these, 177 individuals (78.7%) were younger than 40 years, while 48 individuals (21.3%) were older than 40 years. Out of 225 cases, 146 cases were AA (64.9%), 27 (12%) appendicular abscess cases, and 41 (18.2%) appendicular perforation cases. The normal appendix was noted in 11 out of 225 cases in the low-score group. The association between the histopathological report and RIPASA score was found to be statistically highly significant (p=0.000). In the low-score group, there were 14 cases of appendicitis (53.8%), one case of appendicular abscess (3.8%), a total of 11 cases without pathology observed (42.3%), and no reported instances of appendicular perforation. In the intermediate-score category, there were 121 cases of appendicitis (89.6%), 12 cases of appendicular abscess (8.9%), 2 cases of appendicular perforation (1.5%), and no reported cases in the non-pathology category. Among the high-score category, there were 11 cases of appendicitis (17.2%), 14 cases of appendicular abscess (21.9%), 39 cases of appendicular perforation (60.9%), and no reported instances of negative appendectomy. Conclusion The study has shown that the RIPASA scoring system had a high diagnostic efficacy in identifying AA. This scoring system is an effective, dependable, cost-effective, noninvasive, reproducible, and safe diagnostic technique that does not require additional expenses or concerns.

A COMPARATIVE STUDY TO EVALUATE THE POSITIVE PREDICTIVE VALUE OF BIOCHEMICAL MARKERS WITH CLINICAL RIPASA SCORE IN ACUTE APPENDICITIS: AN IN VIVO STUDY

Objective: We evaluated the positive predictive value of biochemical markers with clinical Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score and the sensitivity and diagnostic accuracy. Methods: 75 patients who presented to the Emergency/General Surgery Department of Pacific Medical College and Hospital, Udaipur, with right iliac fossa (RIF) pain and who were suspected of acute appendicitis. A detailed history, clinical examination, and laboratory investigations were done which included a routine RIPASA score calculated. Results: RIF pain was present in all the patients, followed by vomiting (98.67%), and fever in 92%. Twenty-one patients had raised white blood cell (WBC) counts, out of them 15 patients had both raised WBC counts and raised C-reactive protein (CRP) and 6 had normal CRP. 52 patients had raised CRP levels, out of them 15 patients had both raised WBC counts and raised CRP and 37 had normal WBC counts. 17 patients had both CRP and WBC counts in normal range, but were diagnosed to have appendicitis according to RIPASA score. Our results show that raised CRP and WBC counts had a sensitivity of 28.85% and specificity of 73.91% with a diagnostic accuracy of 42.67%. Conclusion: When combined with WBC, CRP has good discriminatory power for appendicitis despite its inability to reliably predict acute appendicitis when used alone. However, a cutoff point for CRP that predicted perforated appendicitis could not be determined.

A Comparison of the Modified Alvarado Score and the Raja Isteri Pengiran Anak Saleha Appendicitis (Ripasa) Score in a Southeast Asian Population With Histopathology as the Gold Standard.

Background The diagnosis of acute appendicitis has remained difficult despite it being one of the most common surgical emergencies in the world. One of the most frequently used scoring systems is the Modified Alvarado Score (MAS). However, the MAS has been known to be less efficient in Asian populations. To overcome this issue, the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score has been specifically developed to improve the diagnosis of acute appendicitis in Asian populations. This study aimed to evaluate the accuracy of the RIPASA score compared to the MAS for the diagnosis of acute appendicitis in a Southeast Asian population keeping histopathology as the gold standard. Methodology The study group comprised 150 patients. Data were collected from each patient using a simple proforma to ascertain both the MAS and the RIPASA score for each patient at the time of presentation. The patients then underwent open appendectomy and histopathology was used as the gold standard to determine the presence or absence of acute appendicitis in the excised specimens. Results The RIPASA score had a sensitivity and specificity of 89.83% and 59.38%, respectively, compared to 64.41% and 53.12%, respectively, for the MAS. Diagnostic accuracy was similarly higher for the RIPASA score at 83.33% versus 62.00% for the MAS. Conclusions The RIPASA score is superior to the MAS for the diagnosis of acute appendicitis. Using the RIPASA score instead of the MAS in Southeast Asian populations can lead to a more accurate and timely clinical diagnosis of patients with suspected acute appendicitis and help improve patient outcomes.

RIPASA versus Alvarado score in the assessment of acute appendicitis: A prospective study.

This study aimed to compare Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado scoring to accurately identify acute appendicitis. A cross-sectional prospective study was carried out in the department of surgery. Patients were enrolled and scored using RIPASA and Alvarado scoring systems. Appendectomy was done, and the specimen was sent for histopathology examination, which was used as the gold standard for diagnosis. Among 400 recruits, 11 patients were lost to follow-up, giving us a sample size of 389 patients. The cut-off value for RIPASA and Alvarado scores was 7.5 and 7.0, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy in diagnosing acute appendicitis of both scores were analyzed using SPSS. Among 389 patients, 256 (66%) were males, and 277 (71%) were under the age of 40 years. RIPASA was more than 7.5 in 345 cases, while Alvarado was more than 7.0 in 261 patients. RIPASA score had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 95.8%, 87.9%, 98.9%, and 65.9%, respectively. In contrast, the ALVARADO score was 71.1% sensitive and 75.8% specific. RIPASA had a diagnostic accuracy of 95.12%, while Alvarado was only 71.46% accurate in diagnosing acute appendicitis. Compared to the Alvarado scoring system, RIPASA is a better tool in terms of accuracy, sensitivity, and specificity for diagnosing acute appendicitis.

Efficacy in Predicting Negative Appendectomy Rates in Operated Acute Appendicitis Patients Using the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) Score Versus Modified Alvarado Score.

Introduction Acute appendicitis is the commonest abdominal surgical emergency globally. The most accepted management of acute appendicitis is surgical, either open or laparoscopic appendectomy. Overlapping clinical presentations with many genitourinary and gynecological conditions lead to difficulty in accurate diagnosis, making negative appendectomies an unwanted reality. With the advancement in technology, there have been constant efforts to minimize negative appendectomy rates (NAR) using imaging modalities like USG of the abdomen and the gold-standard imaging test, the contrast-enhanced computed tomography of the abdomen. Due to the cost incurred and the lesser availability of such imaging modalities and needed expertise in resource-poor settings, various clinical scoring systems were devised to accurately diagnose acute appendicitis and thereby decrease NAR. We conducted our study to determine the NAR between the Raja Isteri Pengiran Anak Saleha Appendicitis score (RIPASA) and the modified Alvarado (MA) scoring methods. Methods A prospective observational analytical study was conducted, including 50 patients presenting to our hospital with acute appendicitis and who underwent emergency open appendectomy. The need to operate was decided by the treating surgeon. Patients were stratified by both scores; the pre-operative scores were noted and were later compared with the histopathological diagnosis. Results A total of 50 clinically diagnosed patients with acute appendicitis were evaluated utilizing the RIPASA and the MA scores. The NAR was 2% using the RIPASA score vs 10% with the MA score. The sensitivity was 94.11% vs70.58% (p<0.0001), the specificity was 93.75% vs 68.75% (p<0.0001), the positive predictive value (PPV) of 96.96% vs 82.75% (p<0.001), the negative predictive value (NPV) of 88.23% vs 52.38% (p<0.001), and NAR of 2% vs 10% (p<0.0001) in the RIPASA vs MA scoring method, respectively. Conclusions RIPASA score is highly efficacious and statistically significant in diagnosing acute appendicitis with higher PPV at higher scores and higher NPV with lower scores leading to decreased NAR compared with MA score.

Alvarado or RIPASA? Which one do you use to diagnose acute appendicitis?: A cross-sectional study.

Acute appendicitis is one of the most common causes of lower abdominal pain, which is considered a general surgical emergency worldwide. The present study aimed to compare the diagnostic value of Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado score systems in diagnosing acute appendicitis. A prospective cross-sectional study was conducted at Shahid Sadoughi and Shahid Rahnemoon Hospitals in Yazd between September 2020 and February 2020. The statistical population consisted of all of the patients referred to the Accident and Emergency department with right iliac fossa (RIF) pain. All patients were scored using Alvarado and RIPASA scoring system. sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were computed by using SPSS statistical software. An receiver operating characteristic curve were plotted. In present study, one hundred suspected patients with appendicitis who underwent appendectomy were evaluated. The mean age of our study population was 25.2 ± 12.1 years, and the gender distribution was 57% males and 43% females. The sensitivity, specificity, PPV and NPV of RIPASA were 86.6%, 66.7%, 92.2%, and 52.2%, respectively. The sensitivity, specificity, PPV and NPV of Alvarado score were 67.1%, 72.2%, 91.7%, 32.5%, respectively. The diagnostic accuracy was 68% for Alvarado score and 83% for RIPASA. The area under the curve for RIPASA (0.87) was more than that for Alvarado score (0.77). The RIPASA score system had higher sensitivity, PPV, NPV, and accuracy than the Alvarado one. It is recommended for the physician and surgeon to evaluate patients with RIF pain using the RIPASA score.

A comparative study of modified alvarado scoring and raja isteri pengiran anak saleha appendicitis scoring systems for the diagnosis of acute appendicitis

A comparative study of modified alvarado scoring and raja isteri pengiran anak saleha appendicitis scoring systems for the diagnosis of acute appendicitis

Accuracy of RIPASA and Lintula Scores in Diagnosing Acute Appendicitis Using Surgical Findings as the Gold Standard.

Appendicitis is an inflammation of the vermiform appendix's inner lining that spreads to its other sections. Appendectomy is still the standard way to cure appendicitis. The diagnosis of acute appendicitis is still clinical and supported by a raised neutrophilic count and imaging studies; moreover, scoring systems, such as the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Lintula scores, help the clinicians in the diagnosis. The main objective of this study was to establish the diagnostic accuracy of RIPASA and Lintulascores for acute appendicitis using surgical findings as the gold standard, in an Asian population. This was a retrospective cohort study conducted at the Department of Surgery, Mayo Hospital, Lahore, and Department of Surgery, Services Hospital, Lahore. This study was conducted from January 2020 to January 2022, for the duration of two years. A total of 120 patients were enrolled after meeting the inclusion criteria, and demographic data were obtained. Lintula and RIPASA scores were recorded, and patients were classified as positive or negativebased on histopathological findings. IBMSPSS Statistics,version 26 (IBM Corp., Armonk, NY) was used to evaluate all of the gathered data. The average age of the patients in this study was 37.39±14.36 years, with a male-to-female ratio of 1.14:1. Taking surgical finding as the gold standard, RIPASA scoring had a diagnosis accuracy of 91.67% while the Lintulascore had a diagnostic accuracy of 79.17%. While both the RIPASA and the Lintulascoring systems were accurate, the RIPASA scoring system outperformed the Lintula scoring system when surgical findings were used as the gold standard.

TZANAKIS SCORE AS A TOOL TO DIAGNOSE ACUTE APPENDICITIS.

Background:Appendicitis presents with pain in the right lower quadrant of the abdomen which radiates to other parts which varies with degree of inammation.1 It is one of the most common emergencies in surgery. The accurate diagnosis of acute appendicitis is approximately 70 to 87% and misdiagnosis are common which may result in occurrence of perforation 20% and negative appendectomy 2% to 30%.2 For diagnosis of acute appendicitis it depends on clinical history, presentation, examination and laboratory investigations along with early appendectomy can avoid complications arising from perforation, mass formation, peritonitis. Along with this Ultra sonogram is also tagged with the clinical examination in this condition3. Appendectomy is one of the most commonly performed surgical emergency operations which can mimic other acute conditions of the abdomen in the right iliac fossa pain mainly among the young, the elderly and females. Appendicitis is a common surgical condition in department of surgery, its diagnosis always doubtful and is mainly diagnosed with clinical presentation and laboratory investigation such as total leukocyte count, CRPetc. USG and CTAbdomen and Pelvis also have high sensitivity and specicity but is not cost effective hence results in delay of treatment leading to complication. To reduce such circumstances and to reduce the cost many scorings systems are introduced based on blood investigations, clinical presentation and radiological ndings are performed to diagnose this condition4. Raja IsteriPengiranAnakSaleha Appendicitis (RIPASA) 5, Alvarado6, Tzanakis 1 are most commonly used scoring systems to diagnose acute appendicitis. The aim of this study is to determine the accuracy of three scores in accurate diagnose of acute appendicitis by correlating them with the gold standard of histopathological conrmed appendicitis. Objectives: The objective was to compare the TZANAKIS,Raja IsteriPengiranAnakSaleha Appendicitis (RIPASA), Alvarado, scores in patients with right iliac fossa pain to diagnose acute appendicitis and obtain best scoring system out of these in RL jalappa hospital in cost effective way. Materials And Methods: A.Retrospective descriptive B.Total number of study subjects-135 All patients treated at the RLJalappa Hospital for acute appendicitis between January 2021 and April 2022 were identied through a computer-generated search through the Medical Records Department. Data were extracted retrospectively from hospital records. All patients were evaluated and graded using TZANAKIS, Raja IsteriPengiranAnakSaleha Appendicitis (RIPASA), Alvarado score. Conclusion TZANAKIS score was better in predicting appendicitis in RL Jalappa Hospital compared to other RIPASA and ALVARADO scoring system. It had better sensitivity and specicity than the other two scoring system. It overall reduced negative appendectomy rate and is cost effective with limited characteristics.

Evaluation of the Ripasa Score: A New Scoring System for the Diagnosis of Acute Appendicitis in East of Sudan (Single Center Experience from January to June 2022)

Introduction: Acute appendicitis is one of the most common surgical emergencies. Despite being a common problem, it remains a difficult diagnosis to establish, particularly among the young, the elderly and females of reproductive age the study aimed to compare the efficacy of RIPASA score in the diagnosis of acute appendicitis. We recently developed a scoring system for diagnosis of acute appendicitis. This study prospectively evaluates the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score for the diagnosis of acute appendicitis in patients presenting to the Accident and Emergency department or the Surgical wards with right iliac fossa pain. Materials and Methods: From January to June 2022 consecutive patients presenting to the Accident and Emergency department or the surgical wards with right iliac fossa pain were recruited for the study. The RIPASA score was applied but the decision for radiological investigations or emergency appendicectomy was made based on clinical judgment.

A comparative study of the RIPASA and Alvarado scores in geriatric patients diagnosed with acute appendicitis.

SUMMARYOBJECTIVE:While abdominal pain is one of the most prevalent reasons for seeking medical attention, diagnosing elderly adults with acute appendicitis (AA) may be difficult. In this study, Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado ratings were evaluated for diagnostic accuracy in patients who reported to the emergency department complaining of abdominal pain and received surgery for AA.METHODS:The data of patients over the age of 65 years who reported to the ER and had appendectomy after being diagnosed with AA were evaluated in this retrospective cohort study. For each patient, the diagnostic accuracy of the Alvarado and RIPASA scores was determined individually.RESULTS:A total of 86 patients were included in the research. The average patient was 71.2 years old, with a male preponderance of 46.5%. Alvarado’s score was found to have an area under the curve (AUC) of 0.799, the Youden’s index of 0.549, and a p-value of 0.001 after a receiver operating characteristic (ROC) study of the Alvarado score in identifying the diagnosis of AA. The AUC was 0.886 (95%CI 0.799–0.944), the Youden’s index was 0.642, and a p-value of 0.001 was found in the ROC analysis of the RIPASA score in identifying the diagnosis of AA.CONCLUSIONS:When comparing the two scores used to diagnose AA, we found no statistically significant difference between the RIPASA and Alvarado scores (p=0.09), although the Youden’s index for the RIPASA score was higher.

Validate the Precision of the RIPASA Grading System for the Diagnosis of Acute Appendicitis: A Cross-Sectional Study

Aim: To determine the accuracy of the RIPASA (Raja Isteri Pengiran Anak Saleha Appendicitis) grading system for the diagnosis of acute appendicitis. Study design: A cross-sectional study Place and Duration: This study was conducted at Jinnah Postgraduate Medical Centre Karachi Pakistan from March 2020 to November 2021. Methodology: A total of 150 patients with clinical signs of acute appendicitis were studied. To determine the RIPASA score's validity, testing was assessed for acute appendicitis. Patients with gynecological and urological disorders, appendicular lumps, were excluded from the study. The RIPASA Score chart was employed, and the findings of additional clinical studies corroborated the findings. Results: Among the 150 patients, 80 (53.3%) were males, and 70 (46.66%) were females. The participants' average age was 22 ± 5.4 years. At a cut-off score of 7.5, the RIPASA scoring system exhibited good validation testing. The majority of the population (n=135, 90 %) was under the age of 40, with the minority (n=15, 10%) being over 40. The incidence of appendicitis increases dramatically in the second and third decades. There is no case below the age of ten and no case over the age of sixty years. Conclusion: For the diagnosis of AA, the RIPASA score is more sensitive and specific. This Scoring system is a valid and significant selective power in the diagnosis of appendicitis and in reducing unnecessary admissions and abdominal explorations, especially in the Asian race. Keywords: Acute appendicitis, Histopathology, RIPASA, Validation study

EVALUATION OF MODIFIED ALVARDO SYSTEM IN ACUTE APPENDICITIS IN TRIBAL POPULATION OF GUJARAT

Clinical scoring systems, such as the Alvarado and modied Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%–10%. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specically for Asian populations. The aim of this study was to compare the modied Alvarado with the RIPASA scoring system.This study included 180 patients who underwent appendectomies and were documented as having “acute appendicitis” or “abdominal pain” in the operating theatre logbook (unit B).The sensitivity, specicity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic (ROC) curve of the modied Alvarado and RIPASA scoring systems were derived using SPSS statistical software.A total of 136 patients were included in this study according to our criteria. The cut-off threshold point of the modied Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specicity of 56%. The PPVwas 89.3% and the NPVwas 42.4%. The cut-off threshold point of the RIPASAscore was set at 7.5, which yielded a 94.5% sensitivity and an 88% specicity. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modied Alvarado and RIPASA scoring systems, respectively. The negative appendectomy rate decreased signicantly, from 18.4% to 10.7% for the modied Alvarado, and to 2.2% for the RIPASA scoring system, which was a signicant difference (P&lt;0.001) for both scoring systems.Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specicity than the modied Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations.

Diagnostic test evaluation of Raja Isteri Pengiran Anak Saleha appendicitis score in patients with acute appendicitis

Introduction: The diagnosis of acute appendicitis is still heavy reliant on clinical judgement as the availability and quality of imaging studies are quite variable. The Alvarado score and newer scores have been proposed in recent times, one of which is the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score. It has been developed for a better diagnosis of acute appendicitis; the score includes 14 clinical parameters, which have higher sensitivity, specificity and diagnostic accuracy than Alvarado scoring, especially in the Asian population. Methodology: The objective was to evaluate the diagnostic accuracy of the RIPASA score with respect to histopathologically proven appendicitis. A diagnostic test evaluation was conducted in the surgical wards of a tertiary care centre for 1 year on patients undergoing emergency appendicectomy for acute appendicitis. Consecutive sampling was done on 132 participants. After administering the RIPASA score questionnaire to the patients, the histopathological reports were collected and the scoring system was compared to obtain sensitivity, specificity, predictive values, likelihood ratios and area under curve (AUC). Results: Of the 132 patients, 50.8% were male and 49.2% were female, with the majority of patients <40 years. Among components of the RIPASA score other than age, sex, anorexia, duration of symptoms and Rovsing's sign, all other components had an independent statistically significant association to histologically proven appendicitis. The receiver operating characteristic curve analysis of the RIPASA score showed an AUC of 0.915 (P < 0.0001). The negative appendicectomy rate was about 19.6%. Conclusion: The RIPASA score is a simple scoring system with high sensitivity and specificity for the diagnosis of acute appendicitis. The 14 clinical parameters are easily obtained from a good clinical history and examination and can be easily and quickly applied. Therefore, a decision on the management can be made early and complications can be prevented.

“A COMPARATIVE STUDY OF RIPASA SCORE AND ALVARADO SCORE IN THE DIAGNOSIS OF ACUTE APPENDICITIS”

Acute appendicitis is the most common condition encountered in the Emergency department .Alvarado and Modied Alvarado scores are the most commonly used scoring system used for diagnosing acute appendicitis.,but its performance has been found to be poor in certain population . Hence our aim was to compare the diagnostic accuracy of RIPASA and ALVARADO Scoring system and study and compare sensitivity, specicity and predictive values of these scoring systems. The study was conducted in Government district hospital Nandyal . We enrolled 176 patients who presented with RIF pain . Both RIPASA and ALVARADO were applied to them. Final diagnosis was conrmed either by CT scan, intra operative nding or post operative HPE report. Sensitivity,specicity, positive predictive value, negative predictive value, diagnostic accuracy was calculated both for RIPASA and ALVARADO. It was found that sensitivity and specicity of the RIPASA score in our study are 98.7% and 83.3%, respectively. PPV and NPV were 98.1% and 88.2% and sensitivity and specicity of the Alvardo score in our study are 94.3% and 83.3%, respectively. PPV and NPV were 98% and 62.5%.Diagnostic accuracy of RIPASA score and Alvarado score are 97% and 93% respectively. RIPASA is a more specic and accurate scoring system in our local population when compared to ALVARADO . It reduces the number of missed appendicitis cases and also convincingly lters out the group of patients that would need a CT scan for diagnosis (score 5-7.5 ) BACKGROUND: Acute appendicitis is one of the most commonly dealt surgical emergencies, with a lifetime prevalence rate of approximately 1 one in seven. The incidence is 1.5–1.9 per 1,000 in the male and female population, and is approximately 1.4 times greater in men than in women. Despite being a common problem, it remains a difcult diagnosis to establish, particularly among the young, the elderly and females of reproductive age, where a host of other genitourinary and gynaecological inammatory conditions can present with signs and symptoms that are 2 similar to those of acute appendicitis. A delay in performing an appendectomy in order to improve its diagnostic accuracy increases the risk of appendicular perforation and peritonitis, which in turn increases morbidity and mortality. A variable combination of clinical signs and symptoms has been used together with laboratory ndings in several scoring systems proposed for suggesting the probability of Acute Appendicitis and the possible subsequent management pathway. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and ALVARADO score are new diagnostic scoring systems developed for the diagnosis of Acute Appendicitis and has been shown to have signicantly higher sensitivity, specicity and diagnostic accuracy. AIMS AND OBJECTIVES PRIMARY OBJECT 1. To compare RIPASA Scoring system and ALVARADO Scoring system in terms of diagnostic accuracy in Acute Appendicitis. 2. To study and compare sensitivity, specicity and predictive values of above scoring systems. SECONDARY OBJECT 1. To study the rate of negative appendicectomy based on above scoring systems. CONCLUSION: The RIPASA score is a simple scoring system with high sensitivity and specicity for the diagnosis of acute appendicitis. The 14 clinical parameters are all present in a good clinical history and examination and can be easily and quickly applied. Therefore, a decision on the management can be made early. Although the RIPASA score was developed for the local population of Brunei, we believe that it should be applicable to other regions. The RIPASA score presents greater Diagnostic accuracy and Sensitivity and equal specicity as a diagnostic test compared to the Alvarado score and is helpful in making appropriate therapeutic decisions. In hospitals like ours, the diagnosis of AA relies greatly on the clinical evaluation performed by surgeons. An adequate clinical scoring system would avoid diagnostic errors, maintaining a satisfactory low rate of negative appendectomies by adequate patient stratication, while limiting patient exposure to ionizing radiation, since 21 there is an increased risk of developing cancer with computed tomography, particularly for the paediatric age group.

Comparison of modified Alvarado and RIPASA scoring systems correlated with intra-operative findings in predicting acute appendicitis

Background: Imaging techniques such as ultrasound and CT (computerised tomography) offer to improve clinical outcome by increasing the accuracy of diagnosis. Ultrasound has the great advantage of being radiation free, however it is operator dependant. In comparison, CT can overcome these limitations and greater sensitivity in the diagnosis of acute appendicitis, with reported accuracies of 93-98% but it is expensive and not available at all centre, particularly in countries, like India. Hence we need a scoring system such as MASS (modified Alvarado scoring system) and RIPASA (Raja Isteri Pengiran Anak Saleha appendicitis) scoring system with good sensitivity and specificity. Aim of the present study was to explore the disease on clinical presentation and to compare both scoring systems in diagnosis of acute appendicitis and correlating both the scoring systems with the intra-operative findings.Methods: This was a prospective study done between October 2019 and October 2020 on hundred patients who underwent appendicectomy at Kempegowda institute of medical sciences and research centre, Bengaluru, Karnataka, India.Results: In the study among subjects with appendicitis, there was significant association between combined MASS and RIPASA score and intra-operative findings.Conclusions: In the study combined MASS and RIPASA score with correlated intra-operative findings had diagnostic accuracy in prediction of acute appendicitis.

Comparison of major appendicitis scoring systems on the clinical-histopathological correlation

Aim: We aimed to investigate the predictive value of the four most popular scoring systems, such as Modified Alvarado, Raja Isteri Pengiran Anak Saleha Appendicitis, Tzanakis, and Lintula, for histopathologically proven acute, phlegmonous, and gangrenous/perforated appendicitis. Materials and Methods: We retrospectively reviewed the results of 239 patients who underwent appendectomy between 2016 and 2019 in our department. The patients' demographic data, surgery method, histopathological results of the specimens (uncomplicated acute appendicitis, phlegmonous, and gangrenous/perforated appendicitis) were recorded. The predictivity of Modified Alvarado, Raja Isteri Pengiran Anak Saleha Appendicitis, Tzanakis, and Lintula scoring systems according to the histopathological results was compared.Results: The modified Alvarado scoring system showed statistically significant efficacy in the preoperative distinction of acute, phlegmonous, and gangrenous/perforated appendicitis. Although the Raja Isteri Pengiran Anak Saleha Appendicitis and Tzanakis score systems are effective in acute and gangrenous/perforated differentiation, they did not show statistically significant efficacy between acute and phlegmonous appendicitis. The Lintula scoring system was the weakest among the four and did not show statistically significant efficacy in the distinction of all three diagnoses.Conclusion: The diagnosis of acute appendicitis is easier with the use of scoring systems. Scoring systems can also help signal advanced stage and complicated forms of acute appendicitis, such as phlegmonous and gangrenous/perforated appendicitis. The modified Alvarado was the most correlated scoring system with histopathological results.

Comparative study of raja isteri pengiran anak saleha appendicitis scoring system and alvarado scoring system for clinical diagnosis of acute appendicitis

Introduction: Acute appendicitis is essentially a clinical diagnosis, and there are many places in India where confirmation based on radiological imaging is not available immediately. In such scenarios, clinical scoring system comes handy. Materials and Methods: This paper is based on a study to compare the sensitivity and specificity of Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) Scoring System and Alvarado Scoring System in the clinical diagnosis of acute appendicitis. There is very little literature about RIPASA Scoring System. Results: The Alvarado Scoring System showed that 6%–12.5% of patients had total score of 5–6 (possible), 31%–64.6% had total score of 7–8 (probable) and 11%–22.9% had total score of 9–10 (very probable). Forty-two patients had a total score of ≥7, which is the cut-off score to be considered for confirming appendicitis. RIPASA Scoring System showed that 43%–89.6% of patients had cut-off score >7.5 (suggestive of appendicitis) and only 5%–10.4% of patients had score <7.5 (other causes). Conclusions: RIPASA Scoring System was more sensitive and specific than Alvarado Scoring System in the clinical diagnosis of acute appendicitis.

Effectivity of raja isteri pengiran anak saleha appendicitis scoring system for diagnosing acute appendicitis

Background: Acute appendicitis is a very common cause of acute abdomen, particularly associated with the young and middle age groups. Its diagnosis and management are primarily based on the clinical signs and symptoms. Many scoring systems have been made collaborating the signs and symptoms but do not cater to all population. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system is a relatively newer clinical scoring system, which has been used worldwide with good efficacy in the quick diagnosis of acute appendicitis. Methods: Research was done on 50 patients whose signs and symptoms were clinically suggestive of acute appendicitis. The patients were evaluated using RIPASA scores primarily on admission and were operated on the basis of the surgeon's decision. The scores were compared with the histopathological analysis, and efficacy was analyzed. Results: The sensitivity of the RIPASA score was 94.11%, specificity was 93.75%, positive predictive value was 96.96%, the negative predictive value of RIPASA score was 88.23%, and the diagnostic accuracy of RIPASA score was 94%. Conclusion: RIPASA scoring system is a simple and effective scoring system, which can be used in a bedside manner for an accurate diagnosis of appendicitis.