Clinical Prediction Score for Ruptured Appendicitis in ED

Background. Ruptured appendicitis has a high morbidity and mortality and requires immediate surgery. The Alvarado Score is used as a tool to predict the risk of acute appendicitis, but there is no such score for predicting rupture. This study aimed to develop the prediction score to determine the likelihood of ruptured appendicitis in an Asian population. Methods. This study was a diagnostic, retrospective cross-sectional study in the Emergency Medicine Department of Ramathibodi Hospital between March 2016 and March 2018. The inclusion criteria were age >15 years and an available pathology report after appendectomy. Clinical factors included gender, age>60 years, right lower quadrant pain, migratory pain, nausea and/or vomiting, diarrhea, anorexia, fever>37.3°C, rebound tenderness, guarding, white blood cell count, polymorphonuclear white blood cells (PMN) > 75%, and pain duration before presentation. The predictive model and prediction score for ruptured appendicitis were developed by multivariable logistic regression analysis. Result. During the study period, 480 patients met the inclusion criteria; of these, 77 (16%) had ruptured appendicitis. Five independent factors were predictive of rupture, age>60 years, fever>37.3°C, guarding, PMN>75%, and duration of pain>24 hours to presentation. A score >6 increased the likelihood ratio of ruptured appendicitis by 3.88 times. Conclusion. Using the Ramathibodi Welawat Ruptured Appendicitis Score (RAMA WeRA Score) developed in this study, a score of >6 was associated with ruptured appendicitis.

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Diagnosing Appendicitis at Different Time Points in Children with Right Lower Quadrant Pain: Comparison Between Pediatric Appendicitis Score and the Alvarado Score: Reply

World Journal of Surgery ◽

10.1007/s00268-012-1701-2 ◽

2012 ◽

Vol 36 (10) ◽

pp. 2540-2540 ◽

Cited By ~ 1

Author(s):

Han-Ping Wu ◽

Yun-Ching Fu

Keyword(s):

Quadrant Pain ◽

Lower Quadrant Pain ◽

Alvarado Score ◽

Lower Quadrant ◽

Right Lower Quadrant Pain ◽

Time Points ◽

Right Lower Quadrant ◽

Appendicitis Score

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Diagnosing Appendicitis at Different Time Points in Children with Right Lower Quadrant Pain: Comparison Between Pediatric Appendicitis Score and the Alvarado Score

World Journal of Surgery ◽

10.1007/s00268-011-1310-5 ◽

2011 ◽

Vol 36 (1) ◽

pp. 216-221 ◽

Cited By ~ 20

Author(s):

Han-Ping Wu ◽

Wen-Chieh Yang ◽

Kang-Hsi Wu ◽

Chan-Yu Chen ◽

Yun-Ching Fu

Keyword(s):

Quadrant Pain ◽

Lower Quadrant Pain ◽

Alvarado Score ◽

Lower Quadrant ◽

Right Lower Quadrant Pain ◽

Time Points ◽

Right Lower Quadrant ◽

Appendicitis Score

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RIPASA versus Alvarado score in the assessment of suspected appendicitis in children: a prospective study

Annals of Pediatric Surgery ◽

10.1186/s43159-021-00132-5 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Tülin Öztaş ◽

Muhammet Asena

Keyword(s):

Acute Appendicitis ◽

Scoring Systems ◽

Negative Appendectomy ◽

Quadrant Pain ◽

Lower Quadrant Pain ◽

Alvarado Score ◽

Lower Quadrant ◽

Right Lower Quadrant Pain ◽

Right Lower Quadrant ◽

Ripasa Score

Abstract Background Diagnosis of acute appendicitis remains a problem in children with right lower quadrant pain. 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. Alvarado is one of the most commonly used scoring methods in pediatric patients. The RIPASA score is considered to be a better diagnostic scoring method in adults compared to Alvarado. The present study aims to compare RIPASA and Alvarado scoring systems in determining the possibility of acute appendicitis in children with right lower quadrant pain. This study included 179 consecutive pediatric patients who were referred to pediatric surgery with suspicion of acute appendicitis. The cut-off value was >7.5 for the RIPASA score vs. ≥7 for the Alvarado score. The possibility of appendicitis was divided into three groups for the Alvarado score and four groups for the RIPASA score. Results In this study, 158 of 179 patients were operated on. In 140 of the operated patients, the diagnosis of appendicitis was confirmed by histopathology. The negative appendectomy rate was 11.4%. Specificity and negative predictive value of RIPASA score were higher than those of Alvarado (p<0.001). No difference was found between the two scores concerning sensitivity, positive predictive value, and the area under the receiver operator characteristics curve (p>0.05). Conclusion The RIPASA scoring system can be used as an alternative to the Alvarado scoring system in the management of patients with right lower quadrant pain in emergency services and pediatric outpatient clinics. With the use of the RIPASA score, more patients with a low likelihood of appendicitis can be detected and further contributed to the reduction of the negative appendectomy rate.

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