Diagnostic Accuracy Of RIPASA Scoring System In Presumptive Accurate Diagnosis Of Acute Appendicitis : A case control study

Introduction: The RIPASA scoring system was established specifically for Asians. Chong CF in his study consisting of 312 patients who had an emergency appendectomy concluded that optimal cut-off threshold score for negative appendectomy was 7.5. Objective: To determine the diagnostic accuracy of RIPASA scoring system in presumptive accurate diagnosis of acute appendicitis by taking histopathology as the gold standard. Materials and methods: This Cross Sectional Study was carried out at Surgery department at a tertiary care hospital, Karachi over a period of 6 months, from 15th December 2019 to 15th June 2020. A total of 141 patients of both gender of suspected cases of acute appendicitis presenting with sign and symptoms were included in the study. Patients underwent detailed history, general and physical examination and scoring of patients according to RIPASA scoring scale and then decision of appendectomy was taken on the basis of RIPASA score. Removed appendix samples were sent for histopathology. Results: Age range in this study was from 15 to 50 years with mean age of 30.191±6.09 years and mean RIPASA score was 5.375±1.77. Majority of patients were males (58.9%). RIPASA score diagnosed 28(19.9%) and histopathology diagnosed 27(19.1%) patients with acute appendicitis. RIPASA score showed sensitivity of 85.2%, specificity 95.6%, diagnostic accuracy 94%, PPV 82.1% and NPV was 96.4%. Conclusion: We conclude that RIPASA scoring system is the scoring system of choice in diagnosis of the acute appendicitis with good sensitivity albeit a hit high and specificity albeit a bit low profile.

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Modified Alvarado scoring system as a diagnostic tool for acute appendicitis at a tertiary care teaching hospital, Central India: a cross sectional study

International Surgery Journal ◽

10.18203/2349-2902.isj20173142 ◽

2017 ◽

Vol 4 (8) ◽

pp. 2439

Author(s):

Dilip Kothari ◽

Archana Kothari ◽

Abhishek Kalantri ◽

Pawan Bhambani

Keyword(s):

Acute Appendicitis ◽

Scoring System ◽

Tertiary Care ◽

False Negative ◽

Cross Sectional Study ◽

General Information ◽

Human Beings ◽

Sectional Study ◽

Cross Sectional ◽

Negative Appendicectomy

Background: Acute Appendicitis forms an important emergency in the day-to-day surgical practice. It affects human beings irrespective of age, nationality and religion. Early diagnosis and prompt operative intervention is the key for successful management of acute appendicitis. However, the picture of acute appendicitis may not be classical, and in such situations, a policy of early intervention to avoid perforation may lead to high negative appendicectomy rates.Methods: A total of 80 patients were enrolled in the present cross sectional study. Their ages ranged from eleven to 72 years (mean 32.89 ± 15.87). A proforma containing general information about the patient plus eight variables based on the modified Alvarado scoring system was filled.Results: Histological examination confirmed appendicitis in 54 patients (67.5%). The remaining 26 patients were found to have normal appendix giving a negative appendicectomy rate of 32.5% being 36.8% and 28.3% for males and females respectively.Conclusions: This scoring system is easy, simple and cheap complementary aid for supporting the diagnosis of acute appendicitis. MASS can be used effectively in Indian setup to reduce the incidence of negative appendectomies. The patients are not unduly exposed to risks of delay in intervention or significant increase in number of false negative cases.

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Comparison of acute inflammatory score and Alvarado score in diagnosis of acute appendicitis at a tertiary care hospital

International Surgery Journal ◽

10.18203/2349-2902.isj20175405 ◽

2017 ◽

Vol 4 (12) ◽

pp. 4034

Author(s):

Padmaja Rani Gopalam ◽

M. V. Saila Suman Konidala

Keyword(s):

Acute Appendicitis ◽

Scoring System ◽

Financial Burden ◽

Tertiary Care ◽

Area Under The Curve ◽

High Specificity ◽

Lower Sensitivity ◽

Negative Appendectomy ◽

Care Hospital ◽

Alvarado Score

Background: Acute appendicitis remains as one of the most common surgical entity requiring early intervention. Hence there is always a need to develop a well-designed protocol for diagnosis and to reduce negative appendectomy. The most common and widely applied was Alvarado score and best performed in validating studies, but was observed with few drawbacks. A recently introduced appendicitis inflammatory response score (AIR) was designed to overcome the drawbacks associated with the implementation of Alvarado scoring system. The objective the present study was to evaluate the AIR score on cases of suspicious appendicitis and to compare it with Alvarado scorings system.Methods: A prospective study for a period of two years from March 2015 to February 2017 was conducted on consecutive patients who presented to emergency department and scoring was performed based on the necessary variables.Results: The present study was conducted on 300 cases suspicious of appendicitis. The results analysed showed the area under the ROC curve of the AIR score was 0.94 and better than the area under the curve of Alvarado score of 0.82. The AIR score also did well in difficult cases of women, children when compared to Alvarado score in diagnosis of appendicitis. In our study, in cases with >8 points, a lower sensitivity was observed in AIR scoring than Alvarado scoring (0.26 vs. 0.12), but was associated with higher specificity (1.00 vs. 0.95). In these cases, PPV turned out to be 1.00 for AIR scoring and 0.77 for Alvarado scoring.Conclusions: To conclude, AIR scoring performed well almost equally with Alvarado system with high specificity and high negative predictive value preventing unnecessary negative appendectomies. Follow up of these cases will help in deciding surgical intervention in unnecessary cases. This scoring system also prevents unnecessary and costly radiological investigations thereby reducing the financial burden to the patients.

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Outcome of Alvarado scoring system in the diagnosis of acute appendicitis at a tertiary care teaching hospital

10.53350/pjmhs2115102649 ◽

2021 ◽

Vol 15 (10) ◽

pp. 2649-2651

Author(s):

Afza Saleem ◽

Zahra Ali ◽

Wasif Majeed Chaudhry ◽

Aruj Alam ◽

Muhammad Shoaib ◽

...

Keyword(s):

Acute Appendicitis ◽

Teaching Hospital ◽

Clinical Judgment ◽

Scoring System ◽

Iliac Fossa ◽

Tertiary Care ◽

Accurate Diagnosis ◽

Care Hospital ◽

Alvarado Score ◽

Surgical Residents

Background: Diagnosis of acute appendicitis is usually made on the basis of clinical judgment and experience of the surgeon. It may sometimes become a challenge due to variability in presentation. It is not unusual for surgical residents & consultants to miss the diagnosis. Aim: To evaluate the effectiveness of Alvarado score in making an accurate diagnosis of acute appendicitis and assessing its sensitivity at a tertiary care hospital, in Lahore, Pakistan. Methods: A Prospective observational study was conducted at the department of Surgery, Ghurki Trust Teaching Hospital (GTTH). The data was collected from 117 patients on a self-designed proforma over a one-year period i.e., from 1st January 2018 to 31st December 2018 with the suspected diagnosis of acute appendicitis and who underwent surgery. The variables were evaluated with Alvarado scoring system to assess its effectiveness and sensitivity. The data was analyzed using SPSS vr 23. Results: Demographic results showed 73(62.4%) males and 44(37.6%) female. The mean age was 23 years and most of the patient were in age group 11-20years 55(47%). Abdominal pain was the commonest feature found in all the patients followed by Nausea in 72% and migration of pain to Right Iliac fossa 60%. Complicated appendicitis was found as gangrenous (7.5%) and perforated (6%). 53% of the cases were performed by on-call team consisted of SRs and surgical residents. Conclusion: Alvarado score is an effective scoring system in making an accurate diagnosis of acute appendicitis. It can be very useful in the prompt management of patients with equivocal features and in extreme of ages. Keywords: Acute appendicitis, Clinical scoring, Alvarado score

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Diagnostic accuracy of transabdominal ultrasound in respect to transvaginal ultrasound in diagnosing ectopic pregnancy in a tertiary care hospital of Kolkata taking histopathology as gold standard: a prospective study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20212517 ◽

2021 ◽

Vol 9 (7) ◽

pp. 1965

Author(s):

Prasun Das ◽

Raj Saha ◽

Srijak Bhattacharyya ◽

Swadha Priya Basu ◽

Debopriya Das

Keyword(s):

Diagnostic Accuracy ◽

Ectopic Pregnancy ◽

Transvaginal Ultrasound ◽

Tertiary Care ◽

Cross Sectional Study ◽

Reproductive Age ◽

Care Hospital ◽

Cross Sectional ◽

Diagnostic Parameters ◽

Acute Pelvic Pain

Background: Ectopic pregnancy (EP) represents an important cause of acute pelvic pain in women of reproductive age. Initial evaluation consists of appropriate history and clinical examination followed by pelvic ultrasonography (US) and hormonal assays. Objective of the study was to measure diagnostic accuracy of TAS in respect to TVS in detecting ectopic pregnancy.Methods: This prospective cross sectional study was done for 1 year duration in Nilratan Sircar Medical College and Hospital, Kolkata. 50 patients with suspected ectopic pregnancy were transferred from Gynae emergency ward and trans-abdominal, transvaginal ultrasound were subsequently performed on each. The results were corroborated with histopathology reports..Results: Diagnostic parameters of TAS in respect to HPE:sensitivity 75.5, specificity-80,PPV-97.1, NPV-26.6 (all in percentages). Diagnostic parameters of TVS in respect to HPE:sensitivity 86.6, specificity-80, PPV-97.5, NPV-40 (all in percentages).Conclusions: Sonography by transvaginal route stood way ahead of trans abdominal scan in terms of all diagnostic parameters to correctly evaluate ectopic pregnancy.

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Histopathological analysis of appendectomy specimens in a Tertiary Care Hospital; A descriptive study.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.08.4189 ◽

2020 ◽

Vol 27 (08) ◽

pp. 1570-1574

Author(s):

Ahmed Mujtaba Malik ◽

Gohar Rasheed ◽

Tooba Mazhar ◽

Sara Malik ◽

Maariah Asif ◽

...

Keyword(s):

Carcinoid Tumour ◽

Tertiary Care ◽

Cross Sectional Study ◽

Histopathological Analysis ◽

Negative Appendectomy ◽

Care Hospital ◽

Cross Sectional ◽

Surgical Emergency ◽

Perforated Appendix

Objectives: To analyse the pattern and morphologies of all the surgically resected appendices in the surgical emergency of holy family hospital in relation to gender, age and the percentage of negative appendectomies. Study Design: Descriptive Cross Sectional study. Setting: Surgical Unit 1 Holy Family Hospital, Rawalpindi. Period: January 2013 to April 2019. Material & Methods: 1993 patients (1011 males, 982 females) which underwent appendectomy were included in this study. Structured proforma was made. All the specimens were sent to pathology lab for histopathology. Detailed histopathological report was received in the OPD follow-up of the patient. All the data was analysed using SPSS version 22. Results: Acute appendicitis (57.3%) was the most common morphology followed by suppurative appendicitis (11.1%). One case was carcinoid tumour (0.05%). The incidence of negative appendectomy was 8.42% while the incidence of perforated appendix was 3.5%. Conclusion: Appendicitis is one of the most common surgical Emergency and histopathology is gold standard in definitive diagnosis.

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A comparative study on RIPASA and modified Alvarado score in the diagnosis of acute appendicitis in tertiary care hospital

International Surgery Journal ◽

10.18203/2349-2902.isj20210931 ◽

2021 ◽

Vol 8 (3) ◽

pp. 944

Author(s):

Kodenge Raghavendra Rao ◽

D. Navya Sesha Harika ◽

Suragani V. Narayana ◽

Vinodh Kumar K. S. ◽

Chavala Pavan Kumar Yadav ◽

...

Keyword(s):

Acute Appendicitis ◽

Scoring System ◽

Iliac Fossa ◽

Tertiary Care ◽

Scoring Systems ◽

Care Hospital ◽

Alvarado Score ◽

Modified Alvarado Score ◽

Sensitivity Specificity ◽

Ripasa Score

Background: Acute Appendicitis is common surgical emergencies with a lifetime prevalence of approximately 1 in 7. Despite advances in diagnosis and treatment; acute Appendicitis is still associated with morbidity (10%) and mortality (1-5 %). Presentations of acute Appendicitis can mimic various acute medical and surgical conditions, and the diagnosis is predominantly a clinical one-different scoring systems used for aiding in early diagnosis of Acute Appendicitis and its prompt management. Alvarado score and RIPASA score are the most popular ones. So we retrospectively applied and compared Alvarado and RIPASA score in the diagnosis of acute Appendicitis in Indian population.Methods: In this study, we compared RIPASA score and Alvarado scoring system retrospectively by applying to 74 patients. This study period from November 2018 to March 2020. Both scores were calculated for patients presented with right iliac fossa pain. Sensitivity, specificity, positive predictive value (PPV), negative predictive (NPV), diagnostic accuracy for RIPASA and Alvarado system was calculated.Results: The sensitivity and specificity of the Alvarado score were 85.07% and 57.14% respectively. The sensitivity & specificity of RIPASA score were 91.04% and 71.42% respectively. Accuracy of the Alvarado scoring system is 82.44% and for RIPASA scoring system is 89.18%. The results show that the RIPASA scoring system is a better diagnostic tool for the diagnosis of Acute Appendicitis.Conclusions: RIPASA scoring system is simple, accurate, convenient, and more specific scoring system than the modified Alvarado scoring system for the Indian population.

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A comparative study of RIPASA score and modified Alvarado score in diagnosis of acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20195099 ◽

2019 ◽

Vol 6 (11) ◽

pp. 3937

Author(s):

Waleed Yusif El Sherpiny

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Scoring System ◽

Negative Appendectomy ◽

Alvarado Score ◽

Sensitivity Specificity ◽

Ripasa Score

Background: Various diagnostic criteria have been described for diagnosing acute appendicitis. Of these, Alvarado score has been the most commonly used. The RIPASA score is a new diagnostic scoring system developed for the diagnosis of acute appendicitis and showed higher sensitivity, specificity and diagnostic accuracy as compared to Alvarado score. we want to compare prospectively Alvarado and RIPASA score by applying them to patients attending emergency department complaining of right iliac fossa pain that could probably be acute appendicitis.Methods: Patients with clinically suspected acute appendicitis were classified according to both Alvarado and RIPASA scoring systems before undergoing surgery. Histopathological examination of the removed appendix was taken as the gold standard for diagnosis of acute appendicitis.Results: Among (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 were 88.2%, 14.5%, 73.1%, 32%,and 68% 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 51.2%, 80 %, 91 %, 29%, and 57%, respectively. 87.5% of patients were correctly stratified by RIPASA under higher probability group while only 45% were classified by Alvarado as high probability.Conclusions: RIPASA scoring system showed high sensitivity and diagnostic accuracy in comparison to Alvarado scoring system. So, it can be applied for the diagnosis of acute appendicitis.

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Application of Modified Alvarado scoring system in the diagnosis of acute appendicitis: a study in a tertiary care hospital

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20183876 ◽

2018 ◽

Vol 6 (10) ◽

pp. 3192

Author(s):

Anup Kumar Saha ◽

Ankit Sandhu ◽

Kumar Vikram

Keyword(s):

Acute Appendicitis ◽

Scoring System ◽

Histopathological Examination ◽

Tertiary Care ◽

Scoring Systems ◽

Care Hospital ◽

Alvarado Score ◽

Cross Sectional ◽

Group I ◽

Negative Appendicectomy

Background: Acute Appendicitis is one of the common surgical diseases which require early intervention; however, it may lead to higher negative appendicectomy rates, in uncertain Diagnosis. Negative appendicectomy rate is 20-40%. There are various scoring systems to assist in diagnosis. The aim of this study is to assess the effectiveness of Modified Alvarado Scoring System (MASS) in patients with acute appendicitis in AGMC and GBP Hospital.Methods: This was a cross sectional study to evaluate the effectiveness of MASS in patients presenting with acute appendicitis. The Principal Investigator scored all the patients according to the variables of MASS and divided them into three groups. Group I included patients with MASS of four and below, Group II were patients with MASS of 5-6 and Group III included patients with MASS of seven and above. The diagnosis of acute appendicitis was confirmed by histopathological examination. Data was collected using a coded, pre-tested questionnaire and analyzed using SPSS statistical software version 11.5.Results: In this study, 36 cases out of 42 cases had acute appendicitis. The sensitivity of Modified Alvarado Score of >7 was 85.7% (proportion of true positive). The sensitivity was highest among males i.e., 92% while in females, it was 76.4%. Negative appendicectomy rates were highest among females (23.6%), whereas in case of males it was 8%.Conclusions: The present study has shown that MASS provides high degree of sensitivity, specificity, PPV, NPV and accuracy in the diagnosis of acute appendicitis and has found to be more helpful in and high positive predictive value for male patients as compared to females.

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A prospective study of accuracy of modified Alvarado score in patients with acute appendicitis in tertiary care hospital

International Surgery Journal ◽

10.18203/2349-2902.isj20180807 ◽

2018 ◽

Vol 5 (3) ◽

pp. 937

Author(s):

Suman Parihar ◽

M. S. Parihar ◽

J. L. Kumawat ◽

C. P. Joshi

Keyword(s):

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Scoring System ◽

Tertiary Care ◽

Care Hospital ◽

Alvarado Score ◽

Medical College ◽

Modified Alvarado Score ◽

A Prospective Study

Background: Acute appendicitis is the most common acute emergency of the abdomen. Clinical diagnosis of acute appendicitis is challenging in most of situation. The present study was designed to evaluate the role of modified Alvarado scoring system in diagnosis of acute appendicitis.Methods: One hundred consecutive patients presenting in the department of surgery Geetanjali Medical College and Hospital from January 2014 to 2016 were included. Demographic characteristics, symptoms and signs, laboratory results were recorded. Data was collected using a pre-tested questionnaire and analyzed using statistical calculation.Results: In the present study 100 patients were studied in a period of two years. Maximum percentage of patients were in age group 20-30 years and males dominated the series. The sensitivity and specificity of modified Alvarado score was 91.57% and 76.47% respectively with positive predictive value 95% and negative predictive value 65% and diagnostic accuracy of 89%.Conclusions: This study shows that use of modified Alvarado scoring system in patients with acute appendicitis provides a high degree of diagnostic accuracy.

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