scholarly journals Performance of RIPASA and AIR Scores in a Middle-Eastern Subset of Patients with Suspected Diagnosis of Acute Appendicitis

2020 ◽  
Author(s):  
Mohammed Faisal ◽  
Ahmed Bayoumi ◽  
Ahmed Abo Bakr ◽  
Marcus Edlehamre ◽  
Islam Khaled
Keyword(s):  
Acute Appendicitis ◽  
Low Income ◽  
Low Income Countries ◽  
Risk Scores ◽  
Predictive Values ◽  
Cutoff Value ◽  
Egyptian Population ◽  
Cutoff Values ◽  
Sensitivity Specificity ◽  
Ripasa Score

Abstract Background: Early and definitive acute appendicitis (AA) diagnosis remains a great challenge in clinical practice worldwide. Currently, several risk scores are available for the clinical assessment of AA, although there are differences in their accuracy rates. The aim of the study was to assess and analyze the accuracy of the acute inflammatory response (AIR) and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scores in an Egyptian population. Methods: A series of 310 patients, 61% male with a median age of 18 years, with Rt. Iliac fossa pain were clinically evaluated for suspicion of AA. All patients were assessed using both the AIR and RIPASA scores. Following evaluation, all patients underwent appendectomy. A final diagnosis of AA was based on histopathology. Two predetermined cutoff values for the AIR score and one cutoff value for the RIPASA score was evaluated for sensitivity, specificity, and accuracy. Statistical analysis was performed using SPSS version 22. Cross tabulation was performed to assess sensitivity, specificity, positive and negative predictive values along with other tests for parametric and non-parametric variables.Results: The sensitivities of the RIPASA score cutoff value of ≥7.5 and AIR score cutoff values of >4 and >8 were 83.8%, 92.2%, and 33.1%, accordingly, while the specificities were 69.2%, 76.7%, and 84.6%, respectively. AIR score of >4 (91%) was more accurate compared to AIR score of >8 (37.4%) and RIPASA score of ≥7.5 (82.5%). Conclusion: An AIR score of >4 had better sensitivity, specificity, and accuracy compared to a RIPASA score of ≥7.5 for the Egyptian population. However, an AIR score of >8 was more specific. Therefore, an evaluation of patients in low-income countries using one of these scoring systems is highly recommended to avoids unnecessary hospitalization along in negative individuals, in addition to preventing complications in positive cases.

scholarly journals Performance of RIPASA and AIR Scores in an Egyptian Subset of Patients with Suspected Diagnosis of Acute Appendicitis

2020 ◽  
Author(s):  
Mohamed Faisal ◽  
Ahmed A Bayoumi ◽  
Ahmed Abo Bakr ◽  
Marcus Edlehamre ◽  
Islam Khaled
Keyword(s):  
Acute Appendicitis ◽  
Low Income ◽  
Low Income Countries ◽  
Risk Scores ◽  
Predictive Values ◽  
Cutoff Value ◽  
Egyptian Population ◽  
Cutoff Values ◽  
Sensitivity Specificity ◽  
Ripasa Score

Abstract Background: Early and definitive acute appendicitis (AA) diagnosis remains a great challenge in clinical practice worldwide. Currently, several risk scores are available for the clinical assessment of AA, although there are differences in their accuracy rates. The aim of the study was to assess and analyze the accuracy of the acute inflammatory response (AIR) and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scores in an Egyptian population. Methods: A series of 310 patients, 61% male with a median age of 18 years, with Rt. Iliac fossa pain were clinically evaluated for suspicion of AA. All patients were assessed using both the AIR and RIPASA scores. Following evaluation, all patients underwent appendectomy. A final diagnosis of AA was based on histopathology. Two predetermined cutoff values for the AIR score and one cutoff value for the RIPASA score was evaluated for sensitivity, specificity, and accuracy. Statistical analysis was performed using SPSS version 22. Cross tabulation was performed to assess sensitivity, specificity, positive and negative predictive values along with other tests for parametric and non-parametric variables.Results: The sensitivities of the RIPASA score cutoff value of ≥7.5 and AIR score cutoff values of >4 and >8 were 83.8%, 92.2%, and 33.1%, accordingly, while the specificities were 69.2%, 76.7%, and 84.6%, respectively. AIR score of >4 (91%) was more accurate compared to AIR score of >8 (37.4%) and RIPASA score of ≥7.5 (82.5%). Conclusion: An AIR score of >4 had better sensitivity, specificity, and accuracy compared to a RIPASA score of ≥7.5 for the Egyptian population. However, an AIR score of >8 was more specific. Therefore, an evaluation of patients in low-income countries using one of these scoring systems is highly recommended to avoids unnecessary hospitalization along in negative individuals, in addition to preventing complications in positive cases.

scholarly journals Performance of RIPASA and AIR scores in an Egyptian subset of patients with suspected diagnosis of acute Appendicitis

2020 ◽  
Author(s):  
Mohamed Faisal ◽  
Ahmed A Bayoumi ◽  
Ahmed Abo Bakr ◽  
Marcus Edlehamre ◽  
Islam Khaled
Keyword(s):  
Acute Appendicitis ◽  
Iliac Fossa ◽  
Final Diagnosis ◽  
Risk Scores ◽  
Cutoff Value ◽  
Egyptian Population ◽  
Cutoff Values ◽  
Sensitivity Specificity ◽  
Accuracy Rates ◽  
Ripasa Score

Abstract Background Early and definitive acute appendicitis (AA) diagnosis remains a great challenge in clinical practice worldwide. Currently, several risk scores are available for the clinical assessment of AA, although there are differences in their accuracy rates. Aim To assess and analyze the accuracy of the acute inflammatory response (AIR) and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scores in an Egyptian population. Methods A series of 310 patients, 61% male with a median age of 18 years, with Rt. Iliac fossa pain were clinically evaluated for suspicion of AA. All patients were assessed using both the AIR and RIPASA scores. Following evaluation, all patients underwent appendectomy. A final diagnosis of AA was based on histopathology. Two predetermined cutoff values for the AIR score and one cutoff value for the RIPASA score was evaluated for sensitivity, specificity, and accuracy. Results The sensitivities of the RIPASA score cutoff value of ≥7.5 and AIR score cutoff values of >4 and >8 were 83.8%, 92.2%, and 33.1%, accordingly, while the specificities were 69.2%, 76.7%, and 84.6%, respectively. AIR score of >4 (91%) was more accurate compared to AIR score of >8 (37.4%) and RIPASA score of ≥7.5 (82.5%). Conclusion An AIR score of >4 had better sensitivity, specificity, and accuracy compared to a RIPASA score of ≥7.5 for the Egyptian population. However, an AIR score of >8 was more specific.

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

2018 ◽  
Vol 5 (3) ◽  
pp. 796
Author(s):  
Vamsavardhan Pasumarthi ◽  
C. P. Madhu
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Roc Curve ◽  
Predictive Value ◽  
Scoring System ◽  
Alvarado Score ◽  
Predictive Values ◽  
Sensitivity Specificity ◽  
Ripasa Score

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.

scholarly journals The Diagnostic Value of Serum Gastrin-17 and Pepsinogen for Gastric Cancer Screening in Eastern China

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Hongzhang Shen ◽  
Kangwei Xiong ◽  
Xiangyu Wu ◽  
Sile Cheng ◽  
Qifeng Lou ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Eastern China ◽  
Intraepithelial Neoplasia ◽  
Diagnostic Value ◽  
Diagnostic Efficiency ◽  
Predictive Values ◽  
Cutoff Value ◽  
Cutoff Values ◽  
Significant Difference ◽  
Sensitivity Specificity

Objective. To evaluate the diagnostic value of gastrin-17 (G-17) and pepsinogen (PG) in gastric cancer (GC) screening in China, especially eastern China, and to determine the best diagnostic combination and threshold (cutoff values) to screen out patients who need gastroscopy. Methods. The serum concentrations of G-17 and pepsinogen I and II (PGI and PGII) in 834 patients were analyzed, and the PGI/PGII ratio (PGR) was calculated. According to pathological results, patients can be divided into chronic nonatrophic gastritis (NAG)/chronic atrophic gastritis (CAG)/intraepithelial neoplasia (IN)/GC groups. The differences in G-17, PG, and PGR in each group were analyzed, and their values in GC diagnosis were evaluated separately and in combination. Results. There were differences in serum G-17, PGII, and PGR among the four groups (NAG/CAG/IN/GC) ( P ≤ 0.001 ). In total, 54 GC cases were diagnosed, of which 50% were early GC. There was no significant difference in the PGI levels among the four groups ( P = 0.377 ). NAG and CAG composed the chronic gastritis (CG) group. The G-17 and PGII levels in the IN and GC groups were higher than those in the CG group (both P ≤ oth   C ), while the PGR levels were lower ( P ≤ lower ). When distinguishing NAG from CAG, the best cutoff value for G-17 was 9.25 pmol/L, PGII was 7.06 μg/L, and PGR was 12.07. When distinguishing CG from IN, the best cutoff value for G-17 was 3.86 pmol/L, PGII was 11.92 μg/L, and PGR was 8.26. When distinguishing CG from GC, the best cutoff value for G-17 was 3.89 pmol/L, PGII was 9.16 μg/L, and PGR was 14.14. The sensitivity, specificity, accuracy, and positive and negative predictive values of G-17/PGII/PGR for GC diagnosis were 83.3%/70.4%/79.6%, 51.8%/56.3%/47.8%, 53.8%/57.2%/49.9%, 10.7%/10.9%/9.6%, and 97.8%/96.5%/97.1%, respectively. The sensitivity, specificity, accuracy, and positive predictive and negative predictive values of PGII/G-17 vs. PGR/G-17 vs. PGR/PGII in the diagnosis of GC were 63.0% vs. 70.4% vs. 64.8%, 70.5% vs. 70.1% vs. 60.4%, 70.0% vs. 70.1% vs. 60.7%, 12.9% vs. 14.0% vs. 10.2%, and 96.5% vs. 97.2% vs. 96.1%, respectively. Conclusion. The PGII and G-17 levels in patients with gastric IN and GC were significantly increased, while the serum PGR level was significantly decreased. Serological detection is effective for screening GC. The combination of different markers can improve the diagnostic efficiency. The highest diagnostic accuracy was G-17 combined with PGR, and the best cutoff values were G − 17 > 3.89   pmol / L and PGR < 14.14 .

“A COMPARATIVE STUDY OF RIPASA SCORE AND ALVARADO SCORE IN THE DIAGNOSIS OF ACUTE APPENDICITIS”

2021 ◽  
pp. 25-28
Author(s):  
M. Vijaya Kumar ◽  
Manasa Manasa
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Scoring System ◽  
Local Population ◽  
Scoring Systems ◽  
Signs And Symptoms ◽  
Alvarado Score ◽  
Predictive Values ◽  
Ripasa Score

Acute appendicitis is the most common condition encountered in the Emergency department .Alvarado and Modied 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, specicity 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 conrmed either by CT scan, intra operative nding or post operative HPE report. Sensitivity,specicity, positive predictive value, negative predictive value, diagnostic accuracy was calculated both for RIPASA and ALVARADO. It was found that sensitivity and specicity 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 specicity 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 specic 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 difcult diagnosis to establish, particularly among the young, the elderly and females of reproductive age, where a host of other genitourinary and gynaecological inammatory 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 signicantly higher sensitivity, specicity 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, specicity 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 specicity 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 specicity 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 stratication, 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.

scholarly journals Inter-observer agreement on the evaluation of automated breast volume scanner for breast masses

2022 ◽  
pp. 1-11
Author(s):  
Yingchun Liu ◽  
Lin Chen ◽  
Jia Zhan ◽  
Xuehong Diao ◽  
Yun Pang ◽  
...  
Keyword(s):  
Imaging Modality ◽  
Observer Agreement ◽  
Breast Volume ◽  
Imaging Data ◽  
Predictive Values ◽  
Breast Masses ◽  
Cutoff Value ◽  
Automated Breast Volume Scanner ◽  
The Masses ◽  
Sensitivity Specificity

Objective: To explore inter-observer agreement on the evaluation of automated breast volume scanner (ABVS) for breast masses. Methods: A total of 846 breast masses in 630 patients underwent ABVS examinations. The imaging data were independently interpreted by senior and junior radiologists regarding the mass size ([Formula: see text][Formula: see text]cm, [Formula: see text][Formula: see text]cm and total). We assessed inter-observer agreement of BI-RADS lexicons, unique descriptors of ABVS coronal planes. Using BI-RADS 3 or 4a as a cutoff value, the diagnostic performances for 331 masses with pathological results in 253 patients were assessed. Results: The overall agreements were substantial for BI-RADS lexicons ([Formula: see text]–0.779) and the characteristics on the coronal plane of ABVS ([Formula: see text]), except for associated features ([Formula: see text]). However, the overall agreement was moderate for orientation ([Formula: see text]) for the masses [Formula: see text][Formula: see text]cm. The agreements were substantial to be perfect for categories 2, 3, 4, 5 and overall ([Formula: see text]–0.918). However, the agreements were moderate to substantial for categories 4a ([Formula: see text]), 4b ([Formula: see text]), and 4c ([Formula: see text]), except for category 4b of the masses [Formula: see text][Formula: see text]cm ([Formula: see text]). Moreover, for radiologists 1 and 2, there were no significant differences in sensitivity, specificity, accuracy, positive and negative predictive values with BI-RADS 3 or 4a as a cutoff value ([Formula: see text] for all). Conclusion: ABVS is a reliable imaging modality for the assessment of breast masses with good inter-observer agreement.

scholarly journals Evaluation of validation of Anderson score for diagnosis of acute appendicitis by histopathology

2018 ◽  
Vol 5 (11) ◽  
pp. 3489
Author(s):  
Kanwar Singh Goel ◽  
Sapna Goel
Keyword(s):  
Acute Appendicitis ◽  
Final Decision ◽  
Chi Square ◽  
Predictive Values ◽  
Medical College ◽  
Histopathology Finding ◽  
Chi Square Test ◽  
Common Operation ◽  
Sensitivity Specificity ◽  
Surgery Department

Background: Appendicectomy is a very common operation performed. Removing normal appendix leads to multiphasic problems. Furthermore, appendix has proved to be a useful structure in reconstructive surgeries. We are going to evaluate validation of Anderson score for diagnosis of acute appendicitis and confirm the result by histopathology.Methods: This prospective observational study was performed in Surgery Department in SGT Medical College, Gurugram, Haryana. Total patients were 100. A detailed history was taken, clinical examination and investigations were done. All patients were subjected to Anderson score. Patients were operated. Appendix was sent for Histopathology examination. Analysis of the data was done by SPSS software version 23. Sensitivity, specificity, positive predictive value and negative predictive values were found out. Chi square test was duly applied.Results: In 70 patients, Anderson score was >8, was in favour of acute appendicitis. It means these patients should require surgery. In 30 patients score was <8. Most common histopathology finding was acute appendicitis then diffuse suppurative appendicitis followed by gangrenous appendicitis still followed by diffuse suppurative appendicitis with peri appendicitis.Conclusions: we have found out that if Anderson score is ≥8, appendicectomy should be done. But if Anderson score is <8, as per Anderson scoring system, appendicectomy should not be done, but we should not go by this. We should review the patient, further investigations should be carried out, senior surgeon’s opinion should be taken, and then final decision should be taken.

scholarly journals Role Of C-Reactive Protein in Diagnosis of Acute Appendicitis

2021 ◽  
Vol 10 (4) ◽  
pp. 210-214
Author(s):  
Mirza Tassawar Hussain ◽  
Muhammad Kashif Khan ◽  
Syed Shamsuddin ◽  
Aabid Ali ◽  
Erum Khan ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Correct Diagnosis ◽  
C Reactive Protein ◽  
Diagnostic Dilemma ◽  
Senior Registrar ◽  
Predictive Values ◽  
Reactive Protein ◽  
Highly Sensitive ◽  
Sensitivity Specificity

Background: Appendicitis is a common surgical emergency and diagnostic dilemma. Making the correct diagnosis is often difficult as the clinical presentation varies according to the age of the patient and the position of appendix. The objective of this study was to identify clinical applicability of C- reactive protein, as a diagnostic test for appendicitis. Methods: This prospective study was carried out in Federal government Polyclinic hospital, Islamabad from January to July 2019, 114 patients underwent appendectomy for clinically diagnosed acute appendicitis. The decision to operate the patient was given by senior registrar. The blood samples for C-reactive protein were drawn before taking the patient to the operating theatre. Removed appendices were sent for histopathological confirmation of diagnosis. The C-reactive protein was then compared with the results of histopathology to determine its validity. The data was entered and analysed in SPSS 23. Results: The sensitivity, specificity, positive and negative predictive values of C-reactive protein in patients with clinical diagnosis of acute appendicitis were found to be 94%, 78%, 93% and 74 % respectively. Conclusion: CRP is helpful in making diagnosis of acute appendicitis. It is highly sensitive but has a relatively low specificity.  

scholarly journals RIPASA Score; Its Sensitivity, Specificity in Diagnosing Suspected Acute Appendicitis

1969 ◽  
Vol 11 (3) ◽  
pp. 151-155
Author(s):  
Imtiaz Ahmad Khattak ◽  
Waleed Mabood ◽  
Muhammad Naeem ◽  
Sohaib Ali ◽  
Muhammad Adnan Khan Khattak
Keyword(s):  
Acute Appendicitis ◽  
Scoring System ◽  
Asian Population ◽  
Scoring Systems ◽  
Final Decision ◽  
Senior Registrar ◽  
Alvarado Score ◽  
Negative Report ◽  
Sensitivity Specificity ◽  
Ripasa Score

Background: Among acute emergencies, the most commonly occurring one is Acute appendicitis. Scoring systems have beendeveloped such as Alvarado and Modified Alvarado Scores. RIPASA Score has a higher sensitivity in the Asian population set.Thus, came about the plan of our examination to try things out with this new score and to check whether it undoubtedly performswellto the undertaking.Objectives To determine the sensitivity, specificity of the 16-point RIPASA scoring system in diagnosing suspected acuteappendicitis and its validationin correlation with histopathology.Material and Methods: The study was carried out in Khyber Teaching Hospital Peshawar Pakistan from January 2018 to June2018, Department of General Surgery. A total of 322 patients were included in the study. In ED, resident surgeons filled in theRIPASA Score proforma by taking a detailed history and doing a physical examination, and running labs along withultrasonography. The decisionto perform appendectomy was solelytaken bythe senior registrar which was the final decision andthe sample was sent forH/P later on.Results: Of the 322, patients who went through the surgery for acute appendicitis, 188 (58.4%) were male and 134 (41.6%) werefemale, 284(88.2%) had positive histopathology reports and 38 (11.8%) had a negative report. The sensitivity of the RIPASA Scoreat a cut-off value of 8.0 was 97.98%,with the specificity of 77%, and Positive Predictive value of 97.52%,and a Negative PredictiveValue of 86.3%.Conclusion: The clinical implication of RIPASA score is found to be more beneficial than the traditional Alvarado scoring system,thus could bringthe complications rates of appendectomy to significantly lowerfigures.Keywords: Acute Appendicitis,Alvarado Score,RIPASA Score,AsianPopulation, Sensitivity, Specificity

scholarly journals COMPARISON OF ALVARADO SCORE AND RIPASA SCORE IN THE ACCURATE DIAGNOSIS OF ACUTE APPENDICITIS IN COMBINED MILITARY HOSPITAL RAWALPINDI

2021 ◽  
Vol 71 (5) ◽  
pp. 1519-23
Author(s):  
Muhammad Majid ◽  
Rasikh Maqsood ◽  
Muhammad Ali ◽  
Muhammad Ayub Ashraf Malhi ◽  
Zaki Hussain ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Military Hospital ◽  
Alvarado Score ◽  
Accident And Emergency ◽  
Accident And Emergency Department ◽  
Sensitivity Specificity ◽  
Ripasa Score

Objective: To determine the diagnostic accuracy of Alvarado score and the RIPASA score for acute appendicitis using histopathology as a gold standard. Study Design: Cross sectional validation study. Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Mar to Sep 2018. Methodology: A total number of 270 patients were included in the study presenting with pain right iliac fossa to the Accident and Emergency department. Surgeons and Seniors Residents in Surgery on call in the Accident and Emergency Department. Combined Military Hospital, Rawalpindi, scored the patients with suspicion of acute appendicitis with Alvarado Score and RIPASA score simultaneously. After appendectomy of these patients, the removed appendix was sent for histopathology to confirm whether it was normal or inflamed. A 2x2 table was used for calculating sensitivity, specificity and diagnostic accuracy of the RIPASA score and Alvarado Score. The two scoring systems were then compared for diagnostic accuracy. Results: In our study, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of RIPASA score and Alvarado score for diagnosing acute appendicitis were 92.1%, 62.1%, 95.2%, 48.6%, 88.9% and 72.6%, 68.9%, 95.1%, 23.2%, 72.2% respectively. Conclusion: The diagnostic accuracy of RIPASA score was more than that of Alvarado score in diagnosing acute appendicitis.

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