RIPASA Score Research Articles

A Comparative Analysis Between RIPASA and Alvarado Scoring Systems for the Diagnosis of Acute Appendicitis- A Nepalese Perspective

Introduction: Various diagnostic criteria have been described for acute appendicitis. For decades the most commonly used one has been Alvarado score. RIPASA scoring system has also been developed for Asian population which has shown highest sensitivity and diagnostic accuracy. This study aimed to compare these two diagnostic criteria in Nepalese population attending a tertiary center. Methods: Patients with clinically suspected acute appendicitis were classified according to both Alvarado and RIPASA scoring systems before undergoing surgery. Histopathological examination was taken as the gold standard for diagnosis. Statistical analysis was done using McNemar's test as applicable. Results: Ninety nine (90 %) patients had histologically confirmed appendicitis. With the cut-off value greater than 7.5 for RIPASA score; sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy rates were 94.5%, 27.27 %, 92.16 %, 37.5 %, 88.18% and 7.84% respectively. With the cut-off value greater than 7 for Alvarado score, sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy rates were 71.72%, 72.73 %, 95.95 %, 22.22%, 71.82 %, and 4.05 % respectively. 94.5% of patients were correctly stratified by RIPASA under higher probability group while only 71.8 % were classified by Alvarado (p value= 0.0001). Conclusion: RIPASA scoring system showed high sensitivity and diagnostic accuracy in comparison to Alvarado scoring system. So, this method can be applied in Nepalese setting for the diagnosis of acute appendicitis.

Correlation of Ultrasound and RIPASA Scoring System in the Diagnosis of Acute Appendicitis

Objective: Correlation of Ultrasound and RIPASA scoring system in the diagnosis of acute appendicitis. Study Design: 50 patients presenting to emergency underwent ultrasound and evaluation as per RIPASA scoring system followed by emergency appendicectomy. The sensitivity, specificity, positive and negative predictive value calculated for each goups. Results: The sensitivity, specificity, Positive Predictive Value and Negative Predictive Value for ultrasound were 75.51%, 100%, 100% and 7.69% respectively and that for RIPASA scoring system were 93.9%, 100% 100% and 25% respectively. The negative appendicectomy rate was 2%. Conclusion: RIPASA scoring system may be used for correctly diagnosing acute appendicitis but low sensitivity of ultrasound precludes its routine use and may be used as a complementary tool in diagnosing acute appendicitis. Keywards: Acute Appendictis, RIPASA, Ultrasound.

Relationship between Increasing Ripasa Score and Severity of Acute Appendicitis

Relationship between Increasing Ripasa Score and Severity of Acute Appendicitis

Validity of RIPASA scoring system as a diagnostic tool of acute appendicitis in comparison with Alvarado scoring system in the Arab population

Background: RIPASA scoring has been developed to replace the disappointingly low accuracy Alvarado score in Asian population for diagnosis of acute appendicitis. Objective of present study was to compare the RIPASA and Alvarado score in Arab population and determine their accuracy when applied to our patients in Egypt and Kingdom of Saudi Arabia (KSA).Methods: By applying the RIPASA and Alvarado scores to 100 patients from KSA, 100 patients from Egypt who presented to emergency with right iliac fossa pain. The decisions for appendicectomy were based on clinical judgment only. Histopathology as gold standard was correlated with both scores. ROC curve analysis, sensitivity, specificity, positive predictive value and negative predictive value, diagnostic accuracy for RIPASA and Alvarado system were calculated using SPSS version 20.Results: On comparing both the scoring system in patients of both hospital groups, we found that sensitivity of RIPASA scoring is greater than Alvarado scoring system 95.51% and 73.03% respectively in BTH group, and 97.56% and 79.27% respectively in KASH group, while the specificity of RIPASA scoring system is less than Alvarado scoring system 72.73% and 81.82% respectively in BTH group and 66.67% and 83.33% respectively in KASH group.Conclusions: In our Arab population the RIPASA score could be applied in diagnosis of acute appendicitis with higher sensitivity, NPV and diagnostic accuracy compared to the Alvarado score.

The Prospective Study to Evaluate the Efficacy of ALVARADO Score and RIPASA Score in Diagnosis of Acute Appendicitis and Correlation with Histo- Pathological Findings

The Prospective Study to Evaluate the Efficacy of ALVARADO Score and RIPASA Score in Diagnosis of Acute Appendicitis and Correlation with Histo- Pathological Findings

The RIPASA score for the diagnosis of acute appendicitis: A comparison with the modified Alvarado score

Introduction and objectivesAcute appendicitis is the first cause of surgical emergencies. It is still a difficult diagnosis to make, especially in young persons, the elderly, and in reproductive-age women, in whom a series of inflammatory conditions can have signs and symptoms similar to those of acute appendicitis. Different scoring systems have been created to increase diagnostic accuracy, and they are inexpensive, noninvasive, and easy to use and reproduce. The modified Alvarado score is probably the most widely used and accepted in emergency services worldwide. On the other hand, the RIPASA score was formulated in 2010 and has greater sensitivity and specificity. There are very few studies conducted in Mexico that compare the different scoring systems for appendicitis. The aim of our article was to compare the modified Alvarado score and the RIPASA score in the diagnosis of patients with abdominal pain and suspected acute appendicitis. Material and methodsAn observational, analytic, and prolective study was conducted within the time frame of July 2002 and February 2014 at the Hospital Universitario de Puebla. The questionnaires used for the evaluation process were applied to the patients suspected of having appendicitis. ResultsThe RIPASA score with 8.5 as the optimal cutoff value: ROC curve (area .595), sensitivity (93.3%), specificity (8.3%), PPV (91.8%), NPV (10.1%). Modified Alvarado score with 6 as the optimal cutoff value: ROC curve (area .719), sensitivity (75%), specificity (41.6%), PPV (93.7%), NPV (12.5%). ConclusionsThe RIPASA score showed no advantages over the modified Alvarado score when applied to patients presenting with suspected acute appendicitis.

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

Background: Acute appendicitis despite being a common problem, remains a difficult diagnosis to establish. A delay to diagnose this condition as well as negative appendicectomies should be prevented. The above problems can be avoided by using scoring systems. This study aims to compare the efficacy of Alvarado score and RIPASA score in the diagnosis of acute appendicitis.Methods: In this study, 100 cases of appendicitis were admitted. Alvarado and RIPASA scores were applied to all patients. The scores were compared with post-operative histopathology findings.Results: Alvarado score was positive in 75% cases and RIPASA score was present in 90% cases. Histologically, appendicitis was present in 99% cases.Conclusions: RIPASA score is more efficient in diagnosing acute appendicitis compared to Alvarado score.

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

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.

Sensitivity, Specificity and Reliability of the RIPASA Score for Diagnosis of Acute Appendicitis in Relation to the Alvarado Score

IntroductionIn order to avoid delay in the diagnosis of acute appendicitis and reduce the margin of error, the use of scales has been used. The aim of this study was to compare the effectiveness of the Alvarado and RIPASA scores in the clinical diagnosis of acute appendicitis and to correlate with the histopathological results. MethodsProspective, longitudinal, analytical, comparative and observational study. Patients with abdominal pain syndrome suggestive of acute appendicitis and submitted to surgical intervention were included; the Alvarado and RIPASA scores were simultaneously applied. The pathology report was obtained and the efficacy of both scores for the diagnosis of acute appendicitis was compared. ResultsOne hundred patients were included. It was shown that the RIPASA score demonstrated greater diagnostic accuracy compared to the Alvarado score, with sensitivity of 98.8% and specificity of 71.4% versus 90.7% and 64.3%, respectively. The RIPASA score showed an area under the curve of 0.88 and the Alvarado scale of 0.80. ConclusionsThe RIPASA score is a more specific, convenient and accurate system than the Alvarado score for the Mexican population.

A comparative study of RIPASA score and ALVARADO score in diagnosis of acute appendicitis

Background: The RIPASA Score is a new diagnostic scoring system developed for the diagnosis of Acute Appendicitis which showed higher sensitivity, specificity and diagnostic accuracy compared to ALVARADO Score, particularly when applied to Asian population. Not many studies have been conducted to compare RIPASA and ALVARADO scoring systems. Hence, author want to compare prospectively Alvarado and RIPASA score by applying them to the patients attending the hospital with right iliac fossa pain that could probably be acute appendicitis.Methods: A prospective analysis of 116 cases admitted with RIF pain during a 2 years period was performed. Patients between 15-60 years were scored as per Alvarado and RIPASA scoring system. Histopathological reports of the cases were collected and compared with the scores. ROC curve area analysis was performed to examine diagnostic accuracy of RIPASA and ALVARADO scores.Results: The sensitivity of ALVARADO score is estimated to be 52.08 for a cut off of 6. The specificity is 80%, positive predictive value is 92.59, negative predictive value is 25.81. The Diagnostic accuracy of ALVARADO scoring is found to be 56.9. The sensitivity, specificity, positive predictive value and negative predictive values of RIPASA scoring system are 75%, 65%, 91.14%, 35.14%. The diagnostic accuracy of RIPASA score is 73.28.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.

Sensibilidad, especificidad y fiabilidad de la escala RIPASA en el diagnóstico de apendicitis aguda en relación con la escala de Alvarado

IntroductionIn order to avoid delay in the diagnosis of acute appendicitis and reduce the margin of error, the use of scales has been used. The aim of this study was to compare the effectiveness of the Alvarado and RIPASA scores in the clinical diagnosis of acute appendicitis and to correlate with the histopathological results. MethodsProspective, longitudinal, analytical, comparative and observational study. Patients with abdominal pain syndrome suggestive of acute appendicitis and submitted to surgical intervention were included; the Alvarado and RIPASA scores were simultaneously applied. The pathology report was obtained and the efficacy of both scores for the diagnosis of acute appendicitis was compared. ResultsOne hundred patients were included. It was shown that the RIPASA score demonstrated greater diagnostic accuracy compared to the Alvarado score, with sensitivity of 98,8% and specificity of 71,4% versus 90,7% and 64,3%, respectively. The RIPASA score showed an area under the curve of 0,88 and the Alvarado scale of 0,80. ConclusionsThe RIPASA score is a more specific, convenient and accurate system than the Alvarado score for the Mexican population.

Correlation of Ultrasound and RIPASA Scoring System in the Diagnosis of Acute Appendicitis

Objective: Correlation of Ultrasound and RIPASA scoring system in the diagnosis of acute appendicitis. Study Design: 50 patients presenting to emergency underwent ultrasound and evaluation as per RIPASA scoring system followed by emergency appendicectomy. The sensitivity, specificity, positive and negative predictive value calculated for each group. Results: The sensitivity, specificity, Positive Predictive Value, and Negative Predictive Value for ultrasound were 75.51%, 100%, 100%, and 7.69% respectively, and that for the RIPASA scoring system were 93.9%, 100% 100%, and 25% respectively. The negative appendicectomy rate was 2%. Conclusion: RIPASA scoring system may be used for correctly diagnosing acute appendicitis but the low sensitivity of ultrasound precludes its routine use and may be used as a complementary tool in diagnosing acute appendicitis. Keywords: Acute Appendicitis, RIPASA, Ultrasound.

To Determine Validation of RIPASA Score in Diagnosis of Suspected Acute Appendicitis and Histopathological Correlation with Applicability to Indian Population: a Single Institute Study.

Although acute appendicitis is one of the most common surgical emergencies worldwide, timely accurate diagnosis is always difficult for a surgeon even after availability of recent diagnostic tools. Our study is to determine validation of RIPASA score in diagnosis of acute appendicitis and histopathological correlation. A prospective study of 200 patients presented to emergency or surgical opd with right iliac fossa pain and suspected to have acute appendicitis were included in our study. RIPASA score calculated but appendectomy done on the basis of clinical assessment and hospital protocol and histopathological correlation done with a score. A score of 7.5 is cut off threshold, results compared with previous studies. In our study of 200 patients, M:F ratio of 1.56:1. Sensitivity of the RIPASA score was 95.89℅ with specificity 75.92% and diagnostic accuracy of 90.5%, expected and observed rate of negative appendectomy were 8.5 and 12.35%, respectively. So there is net reduction in negative appendectomy rate by 3.85%. Data analysis done with Statistical Package for Social Science (SPSS) version 21.0. RIPASA score at a cutoff value of 7.5 is easier, cheap, and better diagnostic tool in equivocal case of right iliac fossa pain in Indian scenario of limited availability of recent diagnostic tool in remote areas and affordability of these tool in the available set up, simultaneously, it also helps to reduce negative appendectomy rates.

Comparative Study between Alvarado Score&amp; Ripasa Score in Diagnosis of Acute Appendicitis

Comparative Study between Alvarado Score&amp; Ripasa Score in Diagnosis of Acute Appendicitis

Evaluation of RIPASA score in the diagnosis of acute appendicitis

Background: 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.Methods: In this cross sectional comparative study, 100 cases of pain in the right iliac fossa were admitted and evaluated clinically. RIPASA score was calculated for all. Ultrasound (USG) of abdomen and pelvis was done. A positive RIPASA score or USG finding was the criteria for open appendicectomy. The postoperative histopathological reports were compared with the RIPASA scores.Results: RIPASA score was positive in 90% cases. Histopathologically, appendicitis was present in 99% cases. One case of normal appendix histopathologically had a lower RIPASA score. This indicated that RIPASA score could correctly diagnose acute appendicitis in 90% cases.Conclusions: RIPASA score is an efficient score in the diagnosis of acute appendicitis. As compared with ultrasonography of abdomen and pelvis, the RIPASA score is more diagnostic in cases of acute appendicitis. Negative findings of acute appendicitis on ultrasonography of abdomen and pelvis are not the diagnostic test to rule out appendicitis.

Comparison of Efficacy of Ripasa Scoring System with Modified Alvarado Scoring System in Diagnosing Acute Appendicitis

Comparison of Efficacy of Ripasa Scoring System with Modified Alvarado Scoring System in Diagnosing Acute Appendicitis

To Evaluate Use of Combined Modified Ripasa Scoring and Ultrasonography to Improve Diagnostic Accuracyin Acute Appendicitis

To Evaluate Use of Combined Modified Ripasa Scoring and Ultrasonography to Improve Diagnostic Accuracyin Acute Appendicitis

Comparison of Alvarado and RIPASA scoring systems in diagnosis of acute appendicitis and correlation with intraoperative and histopathological findings

Background: Despite extraordinary advances in modern radiology and laboratory investigations an accurate diagnosis of acute appendicitis cannot be made in atypical cases. No single diagnostic aid can dramatically reduce the rate of negative appendicectomy.Methods: To reduce the rate of negative appendicectomies, application of RIPASA and Alvarado scoring done in every clinically diagnosed cases of appendicitis in a prospective study from January 2015 to January 2016 was done. 100 patients with right lower quadrant abdominal pain fulfilling the inclusion and exclusion criterion underwent appendicectomy in Mahatma Gandhi Hospital, Dr. S.N. Medical college, Jodhpur, Rajasthan, India.Results: The results of both scoring system were reported and were correlated with intraoperative and histopathological findings. Chi-square test was applied to calculate the p-value for the association between the variables of studied. The mean age was 24.86 years (10-80 years) and there were 61 males and 39 females in the study. Histopathological examination confirmed appendicitis in 95 patients with 5 negative appendicectomies. Negative appendicectomy rate for RIPASA and Alvarado score was 2.17% and 1.54% respectively. Accuracy for RIPASA and Alvarado score was 93% and 68% respectively.Conclusions: RIPASA score is a more valuable tool for diagnosing acute appendicitis with 93% accuracy, sensitivity 94.74% and specificity 60%; inspite of sophisticated investigations like CT, thus reducing the cost of treatment and minimize negative appendicectomy rate.

Diagnostic Efficacy of Ripasa Scoring in Acute Appendicitis: A Tertiary Care Centre Study

Diagnostic Efficacy of Ripasa Scoring in Acute Appendicitis: A Tertiary Care Centre Study

Effective Diagnosis of Acute Appendicitis – Comparison of RIPASA and Alvarado Scoring Systems

Effective Diagnosis of Acute Appendicitis – Comparison of RIPASA and Alvarado Scoring Systems