Acute appendicitis is the most common condition encountered in the Emergency department .Alvarado and Modied
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, specicity 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 conrmed either by CT scan, intra operative nding or post operative HPE report.
Sensitivity,specicity, positive predictive value, negative predictive value, diagnostic accuracy was calculated both for RIPASA and
ALVARADO.
It was found that sensitivity and specicity 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 specicity 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 specic 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 difcult diagnosis to establish, particularly among the young, the elderly and females of
reproductive age, where a host of other genitourinary and gynaecological inammatory 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 signicantly higher sensitivity, specicity 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, specicity 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 specicity 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 specicity 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 stratication, 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.
Appendicular Tuberculosis as Manifestation of Gastrointestinal Tuberculosis: A Case Report
