Comparative Study of Alvarado and RIPASA Scoring System in Diagnosing Acute Appendicitis: (original) (raw)
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International Surgery Journal, 2017
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 ...
A comparative study of RIPASA and Alvarado score for the diagnosis of acute appendicitis
International Surgery Journal
Background: Acute appendicitis is a common problem and can be difficult to diagnose at time. There are many scoring systems to predict the diagnosis of acute appendicitis. The most commonly used scoring system is Alvarado scoring system but, it is far from perfect. In this study we compare Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system to Alvarado scoring system in correctly diagnosing acute appendicitis.Methods: This prospective observational study was conducted in the department of general surgery, Sree Gokulam Medical College and Research Foundation. It comprised of 60 consecutive patients who were admitted with suspicion of appendicitis who had right iliac fossa pain. RIPASA and Alvarado scoring was done and compared to histopathology after surgery. Sensitivity, specificity and accuracy was calculated.Results: Majority of the patients were below 30 years of age majority were males 36 (60%). When Alvarado score predicted appendicitis in 31 (51.77%) and RIPA...
Annals of International medical and Dental Research
Background: Diagnostic scores are useful and easy methods which help in reaching surgical decision. These scores make use of clinical, analytical and radiological findings to produce a rationalized model of clinical decision making. The objectives are to analyse clinico-pathological condition of acute appendicitis and to confirm diagnosis by histo-pathological examination and by Alvarado score and RIPASA score. Methods: A prospective study of 100 patients who were suspected enough to warrant surgery for acute appendicitis admitted in St. Stephens Hospital under various surgical units was conducted for a period of 2 years. Base line investigations (full blood count, urine routine examination, USG abdomen and peripheral smear for shift to left) are done. USG is an optional study. Then a specially designed Performa is filled for each patient. These Performa have general information about the patient plus all the variables based on Alvarado and RIPASA score. Results: The sensitivity of RIPASA Score in our study (cut off value of 7.5) is 95.6% while the specificity is 50% .The positive predictive value is 94.5% and negative predictive value is 55.6%. Accuracy of the scoring system is 91%. The sensitivity of Alvarado score (cut off value of 7) in our study is 63.3% while the specificity is 100 .The positive predictive value is 100% and negative predictive value is 23.3 %. Accuracy of the scoring system is 67%. RIPASA score is highly sensitive score for Acute appendicitis at a cut off value of 7.5 in contrast to ALVARADO score which is both sensitive as well as specific at cut off value of 6. Area under ROC curve for ALVARADO score is slightly higher than RIPASA 0.926 vs 0.914 hence we can conclude that ALVARADO score at cut off value of 6 is better than RIPASA but results are not statistically significant. Conclusion: The application of these scoring systems improves diagnostic accuracy and thus consequently reduces complication rates.
Annals of International medical and Dental Research
Background: Acute abdomen is one of the most common surgical emergencies with the life time risk of 7%. The diagnosis of appendicitis is challenging due to overlapping of symptoms with other diseases and variable accuracy of clinical examination. The present study was carried out to diagnose acute appendicitis and its complications, to compare ALVARADO and RIPASA scoring systems and correlating these with intra-operative and histopathological findings. Methods: This prospective study of 100 patients was conducted in Department of Surgery admitted in Muzaffarnagar Medical College and Hospital, Muzaffarnagar. Any patients irrespective of sex admitted with age more than 13 yrs presented with right iliac fossa pain suspected to be acute appendicitis and underwent appendectomy. Diagnosis of acute appendicitis was confirmed by operative findings and histological assessment of the appendectomy specimen. In every clinically diagnosed case, ALVARADO and RIPASA scoring systems were applied. Patients were monitored following admission, surgery and till discharge from the hospital. Intra-operative findings such as length of appendix, site of appendix, presence of gangrene or nor, free fluid present or not, presence of fecolith or not, base of caecum evaluated. Histopathologic findings of operated case were collected and correlated with either scores. Results: Out of 100 patients 64% were males and 36% were females. When Alvarado score applied in the study group; 55 patients were in > 7 group and 45 patients in < 7 group. When correlate with histopathology, 90% patients fall into acute appendicitis group and 10% in nonappendicitis group. RIPASA score revealed that there were 89% patients in high probability of acute appendicitis, while 11% were in low probability. When correlate with histopathology 90% fall into appendicitis group and 10% in nonappendicitis group. Conclusion: In the study we conclude that for the diagnosis of appendicitis both ALVARADO and RIPASA scoring systems were equally good. However, RIPASA score is a useful rapid diagnostic tool for establishing a quick decision in patients with RIF pain. Moreover, it also reduces the cost of expensive radiological investigations and thus making a more cost effective approach for patients belonging to lower socioeconomic group.
International Surgery Journal, 2018
Acute appendicitis is one of the most common surgical emergencies encountered, with a lifetime prevalence rate of one in seven people worldwide. 1 A negative appendicectomy is taken as a surgery performed for a preoperative diagnosis of appendicitis that resulted in normal histopathology examination. Different techniques have been formulated to assist in equivocal cases in order to decrease negative appendicectomy rates. Studies have shown a negative appendicectomy rate of 17% to 36%, when acute appendicitis is diagnosed based on clinical judgment. 2 A number of scoring systems have been used for helping in early diagnosis of acute appendicitis and in its immediate management. These scores make use of clinical history, physical examination and laboratory findings. The Alvarado and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scores are two diagnostic scoring systems developed for the diagnosis of Acute ABSTRACT Background: Acute appendicitis is one of the most common surgical emergencies. Various clinical scoring systems have been used for early diagnosis of acute appendicitis, of which Alvarado score is the most popular but it is found to be less accurate when applied to Asian population compared to RIPASA score. Radiological modalities such as computed tomography (CT) imaging may aid in making a definite diagnosis but will inflate the cost of treatment. This study aims to compare RIPASA and Alvarado scoring system in the diagnosis of acute appendicitis in our population. Methods: It was a comparative cross-sectional study done in 100 patients. RIPASA and Alvarado scores were applied to each patient. Our inclusion criteria were patients presenting with Right iliac fossa pain who subsequently underwent Appendicectomy in the same admission. Exclusion criteria included patients admitted under other specialties, those who underwent previous appendicectomy, elective appendicectomy and those not willing for the study. Results: The sensitivity and specificity of RIPASA score was 95.12% and 66.67% and that of ALVARADO score was 64.63% and 77.78%. The positive predictive value (PPV) and negative predictive value (NPV) of RIPASA score was 92.86% and 75% and that of Alvarado score was 92.98% and 32.5%. The diagnostic accuracy of Alvarado and RIPASA scores were 67.0% and 90.0% respectively. Conclusions: RIPASA scoring system is more accurate and specific scoring system for our population than Alvarado in diagnosing acute appendicitis.
IAR Consortium, 2022
Background: Appendicitis is one of the most frequent diagnoses for emergency department visits resulting in hospitalization. A number of scoring systems have been developed to try to identify people who are likely to have appendicitis and are eligible for surgery. Aim of study: is to compare the accuracy of RIPASA to Alvarado score in the diagnosis of acute appendicitis. Methods: A prospective comparative study that was conducted at Al-Yarmouk Teaching Hospital / Baghdad during the period of one year from 1st of Feb. 2019 till 1st of Feb. 2020. It included 200 patients attended the outpatient clinic or the emergency department in Al-Yarmouk Teaching Hospital complaining from lower abdominal and/or right iliac fossa pain suggestive of acute appendicitis. Scoring was done to diagnose appendicitis by two scoring systems (Alvarado and RIPASA) using the data for each patient. The individual scores were then compared to the final diagnosis made by the clinician and to the recommendations of each scoring system. Results: In this study, most of the patients (172 patients, 86%) underwent appendectomy. We noticed that 44.8% of the operated cases were diagnosed as catarrhal appendicitis. Incidences of rebound tenderness, leukocytosis, migratory pain, ROVSING sign, and right iliac fossa guarding were significantly higher in patients diagnosed with appendicitis than those in patients diagnosed as normal appendix. Means of ALVARADO and RIPASA scores were significantly increased with severity to reach the highest level in patients diagnosed with severe appendicitis than other findings. ALVARADO score was 69.7% sensitive, 87.5% specific, and 74% accurate. RIPASA score was 94.1% sensitive, 62.5% specific, and 86.5% accurate. Conclusion: RIPASA score is more accurate and more sensitive than Alvarado score, in spite of the lower specificity, so that it can be effectively conducted for the better evaluation of acute appendicitis. RIPASA score is simple, non-invasive, and cost effective way to be used in resource limited conditions.
Archives of Academic Emergency Medicine, 2020
Introduction: Many scoring systems have been developed to assist in diagnosis of acute appendicitis (AA). This study aimed to compare the screening performance characteristics of Alvarado, Eskelinen, Ohmann, Raja Isteri Pengiran Anak Saleha (RIPASA), and Tzanakis scores in predicting the need for appendectomy in AA patients. Methods: Our study prospectively evaluated AA patients that were treated in a tertiary hospital’s emergency department. The obtained data were used to calculate Alvarado, Tzanakis, RIPASA, Eskelinen and Ohmann scores. Patients were categorized into two groups according to their histopathological results: positive (PA) and negative appendectomy (NA). The accuracy of different scoring systems in diagnosing AA was investigated. Results: 74 patients suspected to AA with the mean age of 36.68 ± 11.97 years were studied (56.8% male). The diagnosis was histopathologically confirmed in 65 cases (87.8%). Median Alvarado, Tzanakis, RIPASA, Eskelinen and Ohmann scores were...
2010
INTRODUCTION Acute appendicitis is one of the most common surgical emergencies. The Alvarado and modified Alvarado scores have been developed to aid diagnosis, but both scoring systems have poor sensitivity and specificity when applied in Middle Eastern and Asian populations. The aim of this study was to develop a new scoring system that is suitable for the local population. METHODS Clinical data from 312 patients who had undergone an emergency appendicectomy was retrospectively collected and used to generate 15 parameters. The probability was calculated and a score of 0.5, 1.0 or 2.0 was allocated to each parameter. The receiver operating curve (ROC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the new scoring system were derived using the StatsDirect statistical software. RESULTS The 15 parameters and the scores generated were age (less than 40 years is 1 point; greater than 40 years is 0.5 point), gender (male is 1 point; femal...
RIPASA vs Modified Alvarado Scoring System for diagnosis of Appendicitis
Journal of College of Medical Sciences-Nepal
INTRODUCTION: Acute appendicitis is the most common surgical condition presented to the emergency department. Clinical scoring systems such as the Alvarado and modified Alvarado scoring system were developed with the goal of reducing the negative appendectomy rate to 5%–10%. In the other hand the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specifically for Asian population. The aim of this study was to compare the modified Alvarado with the RIPASA scoring system in the Nepalese population. METHODS: This study included 125 patients who had undergone appendectomies from March of 2017 to January 2018. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic (ROC) curve of the modified Alvarado and RIPASA scoring systems were derived using SPSS statistical software. RESULTS: A total of 125 patients were includ...
A Comparative Study of RIPASA Score and ALVARADO Score in the Diagnosis of Acute Appendicitis
Journal of clinical and diagnostic research : JCDR, 2014
Acute appendicitis is one of the most common surgical emergencies. Different techniques have been devised to assist in equivocal cases in attempts to decrease negative appendicectomy rates. A number of scoring systems have been used for aiding in early diagnosis of acute appendicitis and its prompt management of which Alvarado score is the most popular. The accuracy of Alvarado score in the diagnosis of acute appendicitis is disappointingly low in Asian population and RIPASA scoring has been designed for the diagnosis of acute appendicitis in the Asian population. So we prospectively applied and compared Alvarado and RIPASA score in the diagnosis of acute appendicitis in Indian population. We compared prospectively RIPASA and Alvarado scoring system by applying them to 206 patients. Both scores were calculated for patients who presented with right iliac fossa pain during the study period. Depending on clinical judgment appendicectomy was done. Post operative histopathology report wa...