RIPASA Score Research Articles

COMPARISON OF ALVARADO, RIPASA, AND AIR SCORING SYSTEM IN DIAGNOSIS OF ACUTE APPENDICITIS

Accurate and timely diagnosis of acute appendicitis is critical in preventing complications and guiding surgical intervention. The Alvarado, RIPASA, and AIR scoring systems are commonly used diagnostic tools, each with varying performance metrics in different clinical settings. Objective: This study aimed to compare the diagnostic performance and overall accuracy of the Alvarado, RIPASA, and AIR scoring systems for diagnosing acute appendicitis. Methods: This observational study was conducted at Civil Hospital Karachi from December 2023 to May 2024, following ethical approval from the institutional review board. A total of 200 patients aged over 18 years presenting with clinical symptoms suggestive of acute appendicitis were included in the study through non-probability consecutive sampling. Each patient’s data was analyzed using the Alvarado, RIPASA, and AIR scoring systems to evaluate their diagnostic accuracy, sensitivity, specificity, and area under the curve (AUC). Results: The Alvarado score demonstrated a sensitivity of 88.44%, a specificity of 37.04%, and an overall accuracy of 81.50%, with an AUC of 0.667 (p=0.002). The RIPASA score showed a sensitivity of 81.18%, a specificity of 53.33%, and an accuracy of 77.00%, with an AUC of 0.699 (p=0.001). The AIR score displayed a sensitivity of 81.00%, a specificity of 60.00%, and an accuracy of 82.00%, with an AUC of 0.700 (p<0.001). Conclusion: The Alvarado, RIPASA, and AIR scores each demonstrate diagnostic value in identifying acute appendicitis, though their sensitivity and specificity may vary based on the population and clinical setting. Clinicians should consider these variations when selecting a scoring system to optimize diagnostic accuracy for acute appendicitis.

RIPASA Score versus Pediatric Appendicitis Score in Diagnosis of Acute Appendicitis in Pediatric Patients

RIPASA Score versus Pediatric Appendicitis Score in Diagnosis of Acute Appendicitis in Pediatric Patients

Different Recent Scoring Systems for Better Diagnosis of Acute Appendicitis

Abstract Background Acute appendicitis is one of the most common surgical emergencies, with a lifetime prevalence rate of approximately one in seven. Aim of the Work to compare RIPASA score, (AIR) score and Modified Alvarado Score widely and easily used scoring systems, in order to identify which one is the best in sensitivity, specificity, positive predictive value, negative predictive value and accuracy, So which one leads to the most accurate diagnosis of acute Appendicitis. Patients and Methods A randomized prospective study that was conducted in Ain-Shams University Hospitals. The study started in February 2022 till the number of cases is fulfilled. 50 patients presented with RT iliac fossa tenderness. Each patient was scored by the three scoring systems using history, examination, clinical labs. Results 66.0% of cases were positive confirmed histology and (34.0%) cases were negative confirmed histology. There were highly statistically significant difference between Negative Confirmed histology and Positive Confirmed histology regarding RIPASA score, (AIR) score and Modified Alvarado Score. In this study, receiver operating characteristic curve (ROC) shows that the best cut off point of Modified Alvarado Score to detect Positive Modified Alvarado Score group was found >5 * with sensitivity of 87.88%, specificity of 64.71%, PPV of 82.9%, NPV of 73.3% and total accuracy of 77.0%. Conclusion the Appendicitis Inflammatory Response score and Raja Isteri Pengiran Anak Saleha Appendicitis score have high discriminating powers and outperform the Modified Alvarado score. They could aid in selecting patients who require timely surgery or those who require further evaluation. Both these scores have the potential to turn out into scoring systems of choice if future research can substantiate our study findings.

Clinical Scoring Systems to Diagnose Complicated Acute Appendicitis in a Rural Hospital: Are They Good Enough?

Introduction Acute appendicitis (AA) is the most common surgical emergency in developed countries, whose incidence peaks in the second and third decades. The risk of mortality in uncomplicated AA is very low. There are many scoring systems to predict AA. Prediction scores are used less frequently to predict complicated AA. Rural hospitals are often constrained by a lack of round-the-clock imaging or special laboratory services, which may enable accurate diagnosis. Materials and methods This study aimed to determine whether prediction scores without imaging or C-reactive protein (CRP) levels could predict complicated AA in a rural setting. All cases of AA for the previous 13 months were recruited for the study. Demographic data, clinical signs and symptoms, complete blood counts, intraoperative findings, and the corresponding histopathological results were collated. The scoring systems (Alvarado, RIPASA, Tzanakis, and Ohmann) were calculated from the clinical and laboratory data.Demographic variables, clinical features, and histopathological findings are described as frequencies/proportions. Chi-squared and Student's t-tests were used to analyze differences between patients with complicated and uncomplicated AA. A receiver operating curve (ROC) analysis was performed to calculate the area under the curve (AUC) and determine whether appendicitis scores could predict complicated AA. Results There were 76 patients with a mean age of 29.1±13.0 years.Serositis was observed in 65% of the patients; mucosal ulceration was the most common microscopic finding, with a pathological diagnosis of AA in 58 (76.3%) patients. Rovsing's sign and the presence of phlegmon and granuloma were significantly different between those with and without complicated AA. The clinical prediction scores were not significantly different between the two groups.The Tzanakis and Ohmann scores were significant (cutoff: 6.5 and 7.25, p=0.001 and 0.01, respectively) in diagnosing AA (sensitivity/specificity of 98.3/66.7 and 98.3/94.4, respectively). With a cutoff of 5.75, the RIPASA score, with an AUC of 0.663 (p=0.09), showed the highest sensitivity (90.7) and specificity (76.6) for diagnosing complicated AA. Conclusion Diagnosing AA based solely on clinical presentation remains a challenge. This study showed that clinical scores such as those of Alvarado, RIPASA, Tzanakis, and Ohmann could not accurately predict complicated AA. Scoring systems without imaging and intraoperative diagnoses are not infallible; therefore, histopathological examination of the resected appendix is mandatory.

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

Accuracy and Sensitivity of RIPASA Score in Diagnosis of Acute Appendicitis

Accuracy and Sensitivity of RIPASA Score in Diagnosis of Acute Appendicitis

Accuracy and sensitivity of RIPASA score Versus Alvarado score in diagnosis of acute appendicitis.

Accuracy and sensitivity of RIPASA score Versus Alvarado score in diagnosis of acute appendicitis.

A Comparative Study of RIPASA and ALVARADO Scoring Systems in the Diagnosis of Acute Appendicitis

A Comparative Study of RIPASA and ALVARADO Scoring Systems in the Diagnosis of Acute Appendicitis

Diagnostic Accuracy of Alvarado vs. RIPASA Scores with Histopathology as Gold Standard for Acute Appendicitis: A Cross-Sectional Study

Diagnostic Accuracy of Alvarado vs. RIPASA Scores with Histopathology as Gold Standard for Acute Appendicitis: A Cross-Sectional Study

A comparative study of RIPASA score and modified Alvarado score in diagnosis of acute appendicitis

A comparative study of RIPASA score and modified Alvarado score in diagnosis of acute appendicitis

DIAGNOSTIC ACCURACY OF RIPASA SCORE FOR DIAGNOSING ACUTE APPENDICITIS KEEPING HISTOPATHOLOGY AS GOLD STANDARD

The objective of the study was to determine the diagnostic accuracy of the RIPASA score in diagnosing acute appendicitis using histopathology as the gold standard. The cross-sectional study was conducted at the General Surgery Department of Lady Reading Hospital, Peshawar, between 17-03-2020 and 16-092020. A total of 171 patients were enrolled in the study. Each patient underwent the RIPASA score, followed by an appendectomy. The appendix specimen obtained during the appendectomy was sent to the laboratory for histopathology. After receiving the histopathology study's objective, which was to determine the report, the results of histopathology, RIPASA score, and other information, including name, age, gender, and age group, were recorded. The age distribution in the sample varied from 15-65 years, with a mean age of 25.8±11.0 years. There were 114 males (66.7%) and 57 females (33.3%). The RIPASA score had a sensitivity of 94.9%, specificity of 64.2%, PPV of 96.7%, NPV of 52.9%, and accuracy of 92.4%. Stratification was also carried out for age and gender. Age 15-25 showed a sensitivity of 94%, specificity of 57.1%, PPV of 97.3%, NPV of 36.3%, and accuracy of 91.9%. Similarly, the age 26-65 group revealed a sensitivity of 97.5%, specificity of 71.4%, PPV of 65.1%, NPV of 83.3%, and accuracy of 93.6%. Stratification by gender showed a sensitivity of 94.2%, specificity of 66.6%, PPV of 97%, NPV of 50%, and accuracy of 92.1% for males, while for females, the sensitivity was 96.1%, specificity was 60%, PPV was 96.1%, NPV was 60%, and accuracy was 92.9%. In conclusion, the study suggests that the RIPASA scoring system is a good choice for doctors in the emergency department to aid in diagnosing acute appendicitis with good sensitivity, albeit with a slightly high profile and specificity, albeit with a bit low profile.

COMPARISON OF RIPASA AND ALVARADO SCORING SYSTEM IN DIAGNOSIS OF ACUTE APPENDICITIS IN TERTIARY CARE

Introduction: Acute appendicitis is one of the most common surgical emergencies, with a lifetime prevalence rate of approximately one in seven. Different techniques have been devised to assist in equivocal cases in attempts to decrease negative appendectomy rates. RIPASA and ALVARADO scores are new diagnostic scoring systems for diagnosis of acute appendicitis . RIPASA scoring system has more sensitivity, specificity and diagnostic accuracy than ALVARADO score in diagnosis of acute appendicitis in Asian population. Hence this study conducted to compare RIPASA AND ALVARADO score in diagnosis of acute appendicitis in tertiary care hospital. RIPASA score includes more parameters than ALVARADO score such as age, gender, duration of symptoms prior to presentation Aims and objectives: To compare RIPASA and Alvarado score in diagnosing acute appendicitis using histopathology as gold standard Materials and Methods: Source of Data: Basaveshwar teaching and general hospital from august 1st to 30th september 2022 Study Design: Prospective observational study. Study Population: 74 patients Inclusion criteria All patients who presented with right lower quadrant abdomen pain and diagnosed as acute appendicitis. Exclusion Criteria: Patients under 18 years of age. Patients with right iliac fossa mass. Patients with features of peritonitis All these patients were scored as per RIPASA and Alvarado scoring system after taking history , clinical examination and laboratory investigations. RIPASA includes 18 parameters and Alvarado 8 parameters. A score of 7.5 taken as high probability of acute appendicitis as per RIPASA and score of 7 for Alvarado scoring system. The decision of appendicectomy solely based on surgeonÂ’s own clinical judgement After the surgery, histopathological reports of operated cases correlated with scoring systems.

Comparative Study between RIPASA Scoring System and ALVARADO Scoring System in Diagnosing Acute Appendicitis in Adults

Background: Acute appendicitis is regarded as one of the most common inflammation that needs surgical intervention. Different scoring systems have been used for diagnosing of acute appendicitis. ALVARADO score is one of the most widely used score in diagnosing of acute appendicitis, but the accuracy of the latter is insufficiently low in Middle-East patients. Thus a new scoring system called RIPASA score has been designed for diagnosing of acute appendicitis in those patients. The aim of this study is to use RIPASA score and compare its result with ALVARADO score in diagnosing of acute appendicitis. Subjects and Methods: The study includes 200 patients with symptoms and signs of acute appendicitis in Al-Kindy Teaching Hospital/Baghdad/Iraq from 1st of November 2017 to 30th of November 2018. The variables of both scoring systems are registered for each patient included in this study and all patients who are underwent appendectomy their specimens are sent for histopathology. Results: The study includes 200 patients with suspicion of acute appendicitis. By applying both scores for each patient, then comparing the result of the two scores with the histopathology reports; RIPASA score has shown sensitivity, specificity, and diagnostic accuracy (93.6%, 74.4%, 89.5%) more than ALVARADO score (82.8%, 65.1%, 79%) respectively. The area under the receiver operating characteristic (ROC) curve of RIPASA score (0.957) is higher and significantly better than that of ALVARADO score (0.893) with P value <0.05. Conclusions: The RIPASA score is more sensitive, more specific, and has high diagnostic accuracy than ALVARADO score.

Comparative study of Alvarado score and RIPASA score in the diagnosis of acute appendicitis

Background: Acute appendicitis is one of the most common surgical emergencies. Immediate and accurate diagnosis, mainly based on clinical assessment and laboratory results, is of paramount importance in order to reduce complications and mortality rates. Challenging diagnosis and fears of missing an inflamed appendix may lead to a negative appendectomy. Many scoring systems have been developed to reduce ambiguities in the diagnosis of appendicitis. The aim of the present study was to compare the efficacy of Alvarado score and RIPASA score in the diagnosis of acute appendicitis. Methods: This study was conducted in the Department of Surgery, Nehru Hospital, BRD Medical College, over a period of 12 months. A total number of 50 cases with a clinical diagnosis of acute appendicitis were studied. Informed consent was obtained from all registered cases. Results: 48% were male and 52% were females in the study. 70% belonged to <40 years and 30% belonged to >40 years. Among 50 patients, in patients ≥40 years of age, appendicitis was diagnosed in 10 patients and in patients <40 years of age, 24 were diagnosed with appendicitis. Among 50 patients, 24 were males out of which 19 were diagnosed with appendicitis compared to 15 out of 26 females. Anorexia and tenderness in RLQ were present in 100% patients. 100% patients had anorexia, RIF pain and tenderness. Alvarado and RIPASA score showed sensitivity 64.7% and 88.2% respectively. Conclusions: The difference in the diagnostic accuracy between Alvarado and RIPASA scoring system is significant indicating that the RIPASA score is a much better diagnostic tool for the diagnosis of acute appendicitis. When the ROC curve was observed the area under the curve is high for RIPASA scoring system.

RIPASA Score in Diagnosis of Acute Appendicitis: To What Extent Is It Accurate?

RIPASA Score in Diagnosis of Acute Appendicitis: To What Extent Is It Accurate?

Comparison of RIPASA and ALVARADO scores for risk assessment of acute appendicitis: A systematic review and meta-analysis.

In the last decades, several clinical scores have been developed and currently used to improve the diagnosis and risk management of patients with suspected acute appendicitis (AA). However, some of them exhibited different values of sensitivity and specificity. We conducted a systematic review and metanalysis of epidemiological studies, which compared RIPASA and Alvarado scores for the diagnosis of AA. This systematic review was conducted using PubMed and Web of Science databases. Selected studies had to compare RIPASA and Alvarado scores on patients with suspected AA and reported diagnostic parameters. Summary estimates of sensitivity and specificity were calculated by the Hierarchical Summary Receiver Operating Curve (HSROC) using STATA 17 (STATA Corp, College Station, TX) and MetaDiSc (version 1.4) software. We included a total of 33 articles, reporting data from 35 studies. For the Alvarado score, the Hierarchical Summary Receiver Operating Curve (HSROC) model produced a summary sensitivity of 0.72 (95%CI = 0.66-0.77), and a summary specificity of 0.77 (95%CI = 0.70-0.82). For the RIPASA score, the HSROC model produced a summary sensitivity of 0.95 (95%CI = 0.92-0.97), and a summary specificity of 0.71 (95%CI = 0.60-0.80). RIPASA score has higher sensitivity, but low specificity compared to Alvarado score. Since these scoring systems showed different sensitivity and specificity parameters, it is still necessary to develop novel scores for the risk assessment of patients with suspected AA.

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.

Comparing the diagnostic accuracy of modified RIPASA and MASS in patients diagnosed with acute appendicitis in Suez Canal University Hospital Emergency Department: a cross-sectional study

IntroductionAcute appendicitis is the most common surgical condition presented in emergency departments globally. It is also the most common cause of abdominal pain treated surgically, with a lifetime risk of 7%. Recent studies show MASS to be easy, simple and cheap diagnostic tool for supporting the diagnosis of acute appendicitis.The modified RIPASA scoring system includes more parameters than MASS and the latter did not contain certain parameters. These parameters are shown to add to the accuracy of modified RIPASA over MASS especially in Asian population.Aim of this studyThe aim of the study was to improve the diagnosis of acute appendicitis in order to lower the negative appendectomy rates.Patients & methodsThis is cross sectional study, the study included 40 patients presented to the emergency department at Suez Canal University hospital with abdominal pain and suspected clinically as acute appendicitis. Then the decision of surgical intervention was made by surgeons, who were blinded for our study, based on their clinical judgment. Then both scores were calculated for all patients and other clinical data were obtained from patients after accepting being included in our study with an informed consent.After operations, the operating theatre records were obtained and cases pathological investigation of the appendices was done. Then the sensitivity, specificity, positive and negative predictive values were calculated and so the diagnostic accuracy for both scoring systems.ResultsClinically, all the patients were suffering acute right iliac fossa tenderness (100%), rebound tenderness (90%), and nausea/ vomiting (70%). Only 45% had elevated White blood count and 55% had negative urine analysis.Histopathological analysis of appendices of the studied patients showed that 40% of the patients had suppurative appendicitis, one quarter of them had catarrhal appendicitis and only 20% had complicated perforated appendicitis. Meanwhile, about 15% had normal (negative) appendix. Modified RIPASA showed a good discriminative ability in our study where the area under the curve for modified RIPASA was 0.902 (95% CI: 0.798 – 1.00) (p = 0.002). Moreover, a value of 8.5 or higher was found to be the best cut-off point to predict acute appendicitis among patient suspected clinically as acute appendicitis with sensitivity = 70.6%, specificity = 100%, positive predictive value of 100%, and negative predictive value of 37.5% and 75% accuracy.The best cut-off score to diagnose acute appendicitis in our sample based on MASS was fixed at 5.5, where the sensitivity of the MASS reached 47.1%, with specificity of 33.3%, positive predictive value of 80%, negative predictive value of 10% and accuracy 45%.ConclusionThe modified RIPASA score is the best diagnostic scoring system for acute appendicitis if compared to the modified Alvarado score, with the former achieving significantly higher sensitivity and diagnostic accuracy. Modified RIPASA was concluded to be a more applicable and useful score. Negative appendicectomy rates can also be avoided by using modified RIPASA score.

The RIPASA scoring system: A new Era in appendicitis diagnosis

IntroductionEven though acute appendicitis is a common acute abdominal disease, it is nonetheless difficult to detect. In order to minimize the risk of complications and negative exploratory procedures, early and accurate diagnosis is critical.We aimed to compare the predictive accuracy of the RIPASA score in diagnosing acute appendicitis with the gold standard of histopathological proven appendicitis as the gold standard. MethodologyA Prospective Cohort Study was conducted from December 2021 to May 2022 at KRL Hospital. A total of 171 patients who sought treatment for acute RIF pain or suspected appendicitis were included in the study. Patients' surgical proclivities were judged in part based on images and surgeon's expertise. SPSS version 26 was used to enter and analyze the data. This was done using a chi-square test and a Kendall's Tau (Kendall Rank Correlation Coefficient) to evaluate both groups of patients. ResultsAt diagnosis, the mean age was 37.93 10.36 years. Kendall's Tau and Chi Square were shown to be significant in contrast to Alvarado scoring. RIPASA Scoring exhibited a 98.02% positive predictive value, a 96.75% sensitivity, an 82.35% specificity, and 95.3% diagnostic accuracy. ConclusionThe RIPASA score is superior to the Alvarado score when it comes to detecting acute appendicitis in Asian populations. With a brief medical history, a clinical examination, and two simple procedures, parameters can be simply and swiftly obtained in any demographic circumstance.

Comparison of the RIPASA and Labeda Scoring Systems to Assess the Morphological Severity of Acute Appendicitis

BACKGROUND: Acute appendicitis is the most common emergency surgical case, leading to further complications if not treated immediately. Limited diagnostics infrastructure is an obstacle in developing countries, especially in the regions. Therefore, alternatives such as clinical scoring systems are required to assist in diagnosis. AIM: This study aimed to compare the use of the RIPASA and Labeda scores to assess the severity of acute appendicitis morphology by determining the accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and negative appendectomy rate. METHODS: This was a cross-sectional study designed to assess the severity of morphology of intra-operative acute appendicitis in Dr. Chasan Boesoirie Hospital and network hospitals in Ternate, North Maluku, Indonesia. Data regarding patient characteristics, leukocytes, and acute appendicitis severity were collected and analyzed alongside RIPASA and Labeda scores using the Chi-square test. p < 0.05 were considered statistically significant. RESULTS: Of 59 cases, 39 (66.1%) were complicated acute appendicitis and 20 (33.9%) were noncomplicated acute appendicitis. Chi-square test results showed that there was a significant relationship (p ≤ 0.001) between RIPASA/Labeda scores and the severity of acute appendicitis morphology. CONCLUSION: RIPASA and Labeda scores had the same accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for acute appendicitis severity. Thus, RIPASA and Labeda scores can be used by physicians to help establish a diagnosis of acute appendicitis and determine the need for emergency surgery, as well as predict the possibility of morbidity/complications in patients.