Validation of the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system for the diagnosis of acute appendicitis among Ethiopian patients: a multi-institutional observational study.

BACKGROUND: Acute appendicitis is the most common surgical emergency in Ethiopian clinical practice. Although a multitude of scoring systems have been used in clinical practice, none have been universally validated. The purpose of this study was to validate the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system in the Ethiopian context. METHODS: A total of 315 consecutive patients who presented with a presumptive diagnosis of acute appendicitis and were planned to undergo appendectomy were studied. All the studied patients had diagnostic sonography and underwent the RIPASA scoring system. The sensitivity, specificity, positive predictive value, and negative predictive value of RIPASA and ultrasound results with intraoperative gross examinations. RESULTS: The mean age of the participants was 27.4 ± 11.5 years, with a male-to-female ratio of 1.6:1. The concordance between ultrasound and RIPASA for the diagnosis of acute appendicitis was 93.6%. The sensitivity, specificity, positive predictive value, and negative predictive value of RIPASA were 96.2%, 30.8%, 93.9%, and 42.1%, respectively. Similarly, the sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound were 95.3%, 27.8%, 95.6%, and 26.3%, respectively. White cell count and RIPASA scores were weakly correlated with intraoperative stages of acute appendicitis, r(313) = 0.18, p = 0.001, and r(313) = 0.129, p = 0.022, respectively. The rate of a negative appendectomy was 6%. CONCLUSION: RIPASA and ultrasound had equivalent performance in the diagnosis of acute appendicitis. In both cases, the rate of negative appendectomy was low enough to validate RIPASA for clinical practice in low-income institutions where sonographic diagnosis by a conventionally trained radiologist is not available.

The RIPASA score is sensitive and specific for the diagnosis of acute appendicitis in a western population.

AIM: The definitive diagnosis of acute appendicitis (AA) requires histopathological examination. Various clinical diagnostic scoring systems attempt to reduce negative appendectomy rates. The most commonly used in Western Europe and the USA is the Alvarado score. The Raja Isteri Pengiran Anak Saleha appendicitis (RIPASA) score achieves better sensitivity and specificity in Asian and Middle Eastern populations. We aimed to determine the diagnostic accuracy of the RIPASA score in Irish patients with AA. METHODS: All patients who presented to our institution with right iliac fossa pain and clinically suspected AA between January 1 and December 31, 2015, were indentified from our hospital inpatient enquiry database and retrospectively studied. Operating theatre records and histology reports confirmed those who underwent a non-elective operative procedure and the presence or absence of AA. SPSS version 22 was used for statistical analysis. Standard deviation is provided where appropriate. RESULTS: Two hundred eight patients were included in the study (106/51% male, mean age 22.7 ± 9.2 years). One hundred thirty-five (64.9%) had histologically confirmed AA (mean symptom duration = 36.19 ± 15.90 h). At a score ≥7.5, the previously determined score most likely associated with AA in Eastern populations, the RIPASA scoring system demonstrated a sensitivity of 85.39%, specificity of 69.86%, positive predictive value of 84.06%, negative predictive value of 72.86% and diagnostic accuracy of 80% in our cohort. CONCLUSION: The RIPASA score is a useful tool to aid in the diagnosis of acute appendicitis in the Irish population. A score of ≥7.5 provides sensitivity and specificity exceeding that previously documented for the Alvarado score in Western populations. WHAT DOES THIS PAPER ADD TO THE LITERATURE?: This is the first study evaluating the utility of the RIPASA score in predicting acute appendicitis in a Western population. At a value of 7.5, a cut-off score suggestive of appendicitis in the Eastern population, RIPASA demonstrated a high-sensitivity, specificity, positive predictive value and diagnostic accuracy in our cohort and was more accurate than the commonly used Alvarado score.

The role of blood inflammatory markers in the preoperative diagnosis of acute appendicitis.

INTRODUCTION: Acute appendicitis (AA) requires a prompt diagnosis. According to postoperative pathological results, a significant number of appendectomies are performed on a normal appendix (NA). The aim of this study is to evaluate the role of preoperative inflammatory markers in supporting and improving the clinical diagnosis of AA, extracting more information from CBC parameters. METHODS: The study is a retrospective one. The histopathological results of operated appendix from 102 patients, who underwent appendectomy for clinically suspected AA, were extracted from the Galilee Medical Center systems. Two patient groups (NA and true AA) were compared for neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR) and mean platelet volume (MPV). The obtained data were statistically analyzed, using the independent sample t test and Mann-Whitney test. Category data have been compared among groups with the chi-squared test. The primary endpoint of our research was to assess the predictive power of blood biomarkers. RESULTS: Patients with suspected AA, based on clinical picture and contrast enhanced computed tomography (CECT), and with MLR-value ≥0.3357 were 5.25 times more likely than normal to have AA. Patients with NLR-value ≥3.2223 were 7 times more likely than normal to have AA. The differences in PLR and MPV values were not statistically significant. CONCLUSIONS: The NLR and MLR biomarkers can assist in diagnosis of AA. This can be particularly helpful in cases where CECT is contraindicated, as in pregnant women or children.

A Comparison of the Alvarado Score and the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) Score in the Diagnosis of Acute Appendicitis: A Prospective Cohort Study.

Background Diagnosing acute appendicitis remains a problem, especially in teenagers with right lower quadrant pain. Imaging studies aid in accurate diagnosis but have limitations such as cost and availability. The Modified Alvarado Scoring System (MASS) is simple and cost-effective with fewer parameters. The Raja Isteri Pengiran Anak Saleha Appendicitis scoring system (RIPASA), designed for Asian populations, includes more parameters. This study compares the effectiveness of RIPASA and Alvarado scores in diagnosing acute appendicitis in a specific clinical setting. Objectives To compare the scoring systems of RIPASA and Alvarado in the diagnosis of acute appendicitis at a tertiary care hospital. Methods Data has been collected from all patients who attended the NRI general hospital emergency department and outpatient wing with acute appendicitis, admitted as inpatients based on clinical history and relevant investigations. Patients satisfying inclusion and exclusion criteria were selected and the basic investigations were done. Summary statistics were done using mean, standard deviation and proportions. Inferential statistics were done by using an independent t-test, kappa statistic, sensitivity and specificity with a 95% confidence interval (CI). All the measurements are done using the statistical package for the social sciences (SPSS) software version 21.0 (IBM Corp., Armonk, NY, USA) and open epidemiological (OpenEpi) software 3.01. A probability (p) <0.05 is considered as statistically significant. Results A total of 110 patients were analyzed for this study with a majority (39%) of them in the 21-30 age group. In our study, females (53%) outnumbered males (47%). Ultrasound findings in our cohort were acute appendicitis (93%), chronic appendicitis (2%) and normal appendix (5%). However, histopathology reported acute appendicitis (75%), chronic appendicitis (9%) and negative/non-specific (15%). The probability of appendicitis as predicted by Alvarado and RIPASA were 40% and 51% respectively. Definitive diagnosis of appendicitis was made in 16.4% with RIPASA whereas only 5.5% with Alvarado. When comparing the Alvarado and RIPASA scores, the sensitivity or true positive rate was higher for RIPASA (73.63%) than for Alvarado (50.55%). Conclusion There was a significant difference between the mean scores in Alvarado and RIPASA inpatients with scores suggestive of appendicitis and no appendicitis. Diagnostic accuracy was higher in RIPASA scoring compared to ALVARDO scoring. There was a significant statistical difference between the two scoring systems. When it comes to diagnosing in low-resource countries the study recommends a combination of Alvarado and RIPASA scoring systems.

RIPASA versus Alvarado score in the assessment of acute appendicitis: A prospective study.

Objectives: This study aimed to compare Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado scoring to accurately identify acute appendicitis. Material and Methods: A cross-sectional prospective study was carried out in the department of surgery. Patients were enrolled and scored using RIPASA and Alvarado scoring systems. Appendectomy was done, and the specimen was sent for histopathology examination, which was used as the gold standard for diagnosis. Among 400 recruits, 11 patients were lost to follow-up, giving us a sample size of 389 patients. The cut-off value for RIPASA and Alvarado scores was 7.5 and 7.0, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy in diagnosing acute appendicitis of both scores were analyzed using SPSS. Results: Among 389 patients, 256 (66%) were males, and 277 (71%) were under the age of 40 years. RIPASA was more than 7.5 in 345 cases, while Alvarado was more than 7.0 in 261 patients. RIPASA score had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 95.8%, 87.9%, 98.9%, and 65.9%, respectively. In contrast, the ALVARADO score was 71.1% sensitive and 75.8% specific. RIPASA had a diagnostic accuracy of 95.12%, while Alvarado was only 71.46% accurate in diagnosing acute appendicitis. Conclusion: Compared to the Alvarado scoring system, RIPASA is a better tool in terms of accuracy, sensitivity, and specificity for diagnosing acute appendicitis.

A Comparison of the Modified Alvarado Score and the Raja Isteri Pengiran Anak Saleha Appendicitis (Ripasa) Score in a Southeast Asian Population With Histopathology as the Gold Standard.

Background The diagnosis of acute appendicitis has remained difficult despite it being one of the most common surgical emergencies in the world. One of the most frequently used scoring systems is the Modified Alvarado Score (MAS). However, the MAS has been known to be less efficient in Asian populations. To overcome this issue, the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score has been specifically developed to improve the diagnosis of acute appendicitis in Asian populations. This study aimed to evaluate the accuracy of the RIPASA score compared to the MAS for the diagnosis of acute appendicitis in a Southeast Asian population keeping histopathology as the gold standard. Methodology The study group comprised 150 patients. Data were collected from each patient using a simple proforma to ascertain both the MAS and the RIPASA score for each patient at the time of presentation. The patients then underwent open appendectomy and histopathology was used as the gold standard to determine the presence or absence of acute appendicitis in the excised specimens. Results The RIPASA score had a sensitivity and specificity of 89.83% and 59.38%, respectively, compared to 64.41% and 53.12%, respectively, for the MAS. Diagnostic accuracy was similarly higher for the RIPASA score at 83.33% versus 62.00% for the MAS. Conclusions The RIPASA score is superior to the MAS for the diagnosis of acute appendicitis. Using the RIPASA score instead of the MAS in Southeast Asian populations can lead to a more accurate and timely clinical diagnosis of patients with suspected acute appendicitis and help improve patient outcomes.

A Comparative Study of Raja Isteri Pengiran Anak Saleha and Alvarado Scores to Diagnose Acute Appendicitis.

BACKGROUND: Acute Appendicitis is a clinical diagnosis with atypical presentation in young, elderly, females, genitourinary and gynecological conditions. Delayed appendectomy increases the risk of appendicular perforation, sepsis morbidity and mortality. Literature reports as high as 20-40% negative appendectomy. Raja Isteri Pengiran Anak Saleha score has come with higher sensitivity and diagnostic accuracy than Alvarado score in Asian population. This study aims to compare RIPASA and Alvarado score for diagnostic accuracy. METHODS: Appendectomy patients at Patan Hospital from April to September 2014 were compared on raja isteri pengiran anak saleha (cut-off value 7.5 out of 15) and Alvarado score (cut-off value 7 out of 10). Final diagnosis was histopathology based. Microsoft Excel and SPSS 17 were used for analysing sensitivity, specificity and diagnostic accuracy of both scores. The study included patients who underwent appendectomy with histopathology report and excluded those with conservative management, generalized peritonitis, appendicular lump and abscess. RESULTS: There were 88 appendectomy patients with median age 26 (18.25, 35) years, and male 52 (59.1%). Negative appendectomy was 10 (11.36%). Sensitivity and specificity of Raja Isteri Pengiran Anak Saleha 98.71% and 80.00% respectively, and for Alvarado 52.56% and 70%.The Raja Isteri Pengiran Anak Saleha score had statistically significant sensitivity (p=0.000). Positive Predictive value, Negative Predictive Value and diagnostic accuracy were 97.46%, 88.89% and 96.6% for RIPASA and 93.18%, 15.19% and 54.4% for Alvarado respectively. CONCLUSIONS: The Raja Isteri Pengiran Anak Saleha score had better diagnostic accuracy compared to Alvarado score for diagnosis of Acute Appendicitis.

Evaluation Of Modified Alvarado, Ripasa And Lintula Scoring System As Diagnostic Tools For Acute Appendicitis.

BACKGROUND: Commonest surgical emergency presenting to emergency departments with abdominal pain is acute appendicitis. Thus, to enable quick and accurate diagnosis of the condition various scoring systems have been developed. Among these, Alvarado and its modified version (Modified Alvarado) are the commonest. Whereas Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score showed promising results in Asian population. Similarly, Lintula score, which was initially developed for paediatric population, has now been validated for elderly too. This study is aimed to compare these in our regional population. METHODS: Project included consecutive 125 clinically suspected acute appendicitis patients. All were scored using Modified Alvarado, RIPASA and Lintula systems. Final diagnosis was based on histopathologic evaluation of excised specimen. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were computed for all these systems by using SPSS statistical software and ROC curves were plotted. RESULTS: With cut-off of 7, Modified Alvarado was 62% specific, 83% sensitive and 65% accurate. While PPV and NPV were 94% and 33%, respectively. Whereas RIPASA yielded better results, i.e., sensitivity of 98.4%, specificity of 87%, PPV of 97%, NPV of 77% and diagnostic accuracy of 92%. Whereas Lintula showed sensitivity of 71%, specificity of 87%, PPV of 96%, NPV of 40 and accuracy of 73%. CONCLUSIONS: RIPASA demonstrated higher sensitivity, PPV, NPV and diagnostic accuracy than Modified Alvarado and Lintula scores. Hence this study approves use of RIPASA score in the region. However further research on the subject is required to back this inference.

Diagnostic Accuracy Of Ripasa Score.

BACKGROUND: Acute appendicitis is one of the most common acute surgical emergencies on emergency room floor and timely diagnosis of the condition is of utmost importance. Multiple diagnostic Score exist to help in the clinical diagnosis; among Which RIPASA is a recent introduction. METHODS: The study was carried out Ayub Teaching hospital of Abbottabad from Sept-2017 to Feb-2018, Department of General Surgery. The ultimate decision to perform surgery was not guided by the scores and the surgeon's decision was the final word, and specimens were sent afterward for histopathology. The results compiled and entered into SPSS 20. RESULTS: Out of the 308, 288 patients underwent surgery for AP, 165 (57.3%) were male and 123 (42.7%) were female, 252 (87.5%) had positive histopathology report and 36 (12.5%) had a negative report, with resultant negative appendectomy rate of 12.5% well below the average. 26 (9.02%) had a perforated appendix and 8 (2.8%) had post-op wound infection. The sensitivity of RIPASA score at a cut-off value of 7.5 was 98.02%, with specificity of 75%, and Positive Predictive Value of 96.48%, and Negative Predictive Value of 84.7%. Compared to Alvarado's Score Sensitivity and Specificity of 53% and 75% respectively. CONCLUSIONS: On the balance the RIPASA Score detects early preventing from dreadful complication and in turn have low specificity giving way to a slightly higher negative appendectomy rate with the consequent morbidity and mortality of unnecessary surgery. Still RIPASA Score outperforms the Alvarado and Modified Alvarado Score.

To Determine Validation of RIPASA Score in Diagnosis of Suspected Acute Appendicitis and Histopathological Correlation with Applicability to Indian Population: a Single Institute Study.

Although acute appendicitis is one of the most common surgical emergencies worldwide, timely accurate diagnosis is always difficult for a surgeon even after availability of recent diagnostic tools. Our study is to determine validation of RIPASA score in diagnosis of acute appendicitis and histopathological correlation. A prospective study of 200 patients presented to emergency or surgical opd with right iliac fossa pain and suspected to have acute appendicitis were included in our study. RIPASA score calculated but appendectomy done on the basis of clinical assessment and hospital protocol and histopathological correlation done with a score. A score of 7.5 is cut off threshold, results compared with previous studies. In our study of 200 patients, M:F ratio of 1.56:1. Sensitivity of the RIPASA score was 95.89℅ with specificity 75.92% and diagnostic accuracy of 90.5%, expected and observed rate of negative appendectomy were 8.5 and 12.35%, respectively. So there is net reduction in negative appendectomy rate by 3.85%. Data analysis done with Statistical Package for Social Science (SPSS) version 21.0. RIPASA score at a cutoff value of 7.5 is easier, cheap, and better diagnostic tool in equivocal case of right iliac fossa pain in Indian scenario of limited availability of recent diagnostic tool in remote areas and affordability of these tool in the available set up, simultaneously, it also helps to reduce negative appendectomy rates.

Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis.

BACKGROUND: Acute appendicitis is the most common surgical condition presented in emergency departments worldwide. Clinical scoring systems, such as the Alvarado and modified Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%-10%. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specifically for Asian populations. The aim of this study was to compare the modified Alvarado with the RIPASA scoring system in Kuwait population. METHODS: This study included 180 patients who underwent appendectomies and were documented as having "acute appendicitis" or "abdominal pain" in the operating theatre logbook (unit B) from November 2014 to March 2016. 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 136 patients were included in this study according to our criteria. The cut-off threshold point of the modified Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specificity of 56%. The PPV was 89.3% and the NPV was 42.4%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded a 94.5% sensitivity and an 88% specificity. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modified Alvarado and RIPASA scoring systems, respectively. The negative appendectomy rate decreased significantly, from 18.4% to 10.7% for the modified Alvarado, and to 2.2% for the RIPASA scoring system, which was a significant difference (P<0.001) for both scoring systems. CONCLUSION: Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specificity than the modified Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations. The RIPASA scoring system is more accurate and specific than the modified Alvarado scoring system for Kuwait population.

A comparative study of the RIPASA and Alvarado scores in geriatric patients diagnosed with acute appendicitis

SUMMARY OBJECTIVE: While abdominal pain is one of the most prevalent reasons for seeking medical attention, diagnosing elderly adults with acute appendicitis (AA) may be difficult. In this study, Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado ratings were evaluated for diagnostic accuracy in patients who reported to the emergency department complaining of abdominal pain and received surgery for AA. METHODS: The data of patients over the age of 65 years who reported to the ER and had appendectomy after being diagnosed with AA were evaluated in this retrospective cohort study. For each patient, the diagnostic accuracy of the Alvarado and RIPASA scores was determined individually. RESULTS: A total of 86 patients were included in the research. The average patient was 71.2 years old, with a male preponderance of 46.5%. Alvarado's score was found to have an area under the curve (AUC) of 0.799, the Youden's index of 0.549, and a p-value of 0.001 after a receiver operating characteristic (ROC) study of the Alvarado score in identifying the diagnosis of AA. The AUC was 0.886 (95%CI 0.799-0.944), the Youden's index was 0.642, and a p-value of 0.001 was found in the ROC analysis of the RIPASA score in identifying the diagnosis of AA. CONCLUSIONS: When comparing the two scores used to diagnose AA, we found no statistically significant difference between the RIPASA and Alvarado scores (p=0.09), although the Youden's index for the RIPASA score was higher.

A comparison between modified Alvarado score and RIPASA score in the diagnosis of acute appendicitis.

Acute appendicitis is a common but elusive surgical condition and remains a diagnostic dilemma. It has many clinical mimickers and diagnosis is primarily made on clinical grounds, leading to the evolution of clinical scoring systems for pin pointing the right diagnosis. The modified Alvarado and RIPASA scoring systems are two important scoring systems, for diagnosis of acute appendicitis. We prospectively compared the two scoring systems for diagnosing acute appendicitis in 50 patients presenting with right iliac fossa pain. The RIPASA score correctly classified 88 % of patients with histologically confirmed acute appendicitis compared with 48.0 % with modified Alvarado score, indicating that RIPASA score is more superior to Modified Alvarado score in our clinical settings.

Comparison of multislice computed tomography and clinical scores for diagnosing acute appendicitis.

OBJECTIVE: To compare Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado scores with multislice computed tomography (MSCT) for diagnosing acute appendicitis (AA). METHODS: This retrospective study included patients with abdominal pain who had undergone MSCT, and whose medical notes included RIPASA and Alvarado score parameters. MSCT was compared with RIPASA and Alvarado scores for diagnosing AA. RESULTS: Of 297 patients included, sensitivity, specificity and accuracy for diagnosing AA were 95.2%, 73.6% and 87.2% for RIPASA score (cutoff value 7.5) and 63.1%, 80.9% and 69.7% for Alvarado score (cutoff value 7). Sensitivity, specificity and accuracy of MSCT for diagnosing AA were 98.9%, 96.4% and 98.0%, respectively. In terms of accuracy, statistically significant differences were observed between RIPASA and Alvarado scores, and between MSCT and RIPASA scores. The mean RIPASA score was significantly different in the simple AA group (9.7 ± 2.2) compared with other AA groups (10.5 ± 1.7). No statistically significant difference was observed in RIPASA score between nonperforated and perforated AA. MSCT sensitivity, specificity and accuracy for diagnosing simple AA were 94.1%, 96.4% and 95.8%, respectively; for differentiating perforated and nonperforated AA, scores were 90.2%, 95.2% and 94.1%, respectively. CONCLUSION: MSCT is the optimum diagnostic tool for AA, followed by RIPASA score and Alvarado score, particularly in diagnosing simple and perforated AA.

Efectividad de la Escala RIPASA para el diagnóstico de apendicitis aguda / Effectiveness of the RIPASA Score for the diagnosis of Acute Appendicitis

RESUMEN Introducción: La apendicitis aguda es la primera causa de atención quirúrgica en los servicios de urgencias de adultos en prácticamente todo el mundo, y la apendicectomía se ha establecido como el estándar de oro del tratamiento. Objetivo: Evaluar la efectividad de la escala RIPASA para el diagnóstico de apendicitis aguda. Métodos: Se desarrolló un estudio observacional-prospectivo de serie de casos en los pacientes con diagnóstico de apendicitis aguda a los que, se les aplicó la escala de RIPASA. Resultados: La escala de RIPASA presentó una efectividad del 90,38 por ciento de los casos estudiados con diagnóstico de apendicitis aguda. En la muestra obtenida, se encontraron 8 mujeres (5,13 por ciento) y 148 hombres (94,87 por ciento). Se evidenció una mayor representatividad en las edades entre 18 y 20 años. Conclusiones: Los sistemas clínicos de puntuación como, el usado en este estudio pueden ser una herramienta económica y de rápida aplicación en los servicios de urgencias para descartar la apendicitis aguda. Este sistema de puntuación es dinámico, lo que permite la observación y la reevaluación crítica de la evolución del cuadro clínico. Su aplicación mejora la precisión diagnóstica y, en consecuencia, reduce las apendicectomías negativas y la presentación de complicaciones(AU)

ABSTRACT Introduction: Acute appendicitis is the leading cause of surgical care in adult emergency services virtually worldwide. Appendectomy has been established as the gold standard of treatment. Objective: To evaluate the effectiveness of the RIPASA score for the diagnosis of acute appendicitis. Methods: An observational-prospective study of case series was carried out in patients diagnosed with acute appendicitis and who were applied the RIPASA score. Results: The RIPASA score showed an effectiveness of 90.38 percent of the cases studied with a diagnosis of acute appendicitis. The sample obtained consisted of eight women (5.13 percent) and 148 men (94.87 percent). Greater representativeness was evident in the ages between 18 and 20 years. Conclusions: Clinical scoring systems, such as the one used in this study, can be an inexpensive tool to be applied quickly in the emergency department to rule out acute appendicitis. This scoring system is dynamic, allowing critical observation and reassessment of the natural history of the condition. Its application improves diagnostic precision and, consequently, reduces negative appendectomies, as well as the onset of complications(AU)

Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis / 世界急诊医学杂志（英文）

@#BACKGROUND: Acute appendicitis is the most common surgical condition presented in emergency departments worldwide. Clinical scoring systems, such as the Alvarado and modified Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%–10%. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specifically for Asian populations. The aim of this study was to compare the modified Alvarado with the RIPASA scoring system in Kuwait population. METHODS: This study included 180 patients who underwent appendectomies and were documented as having "acute appendicitis" or "abdominal pain" in the operating theatre logbook (unit B) from November 2014 to March 2016. 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 136 patients were included in this study according to our criteria. The cut-off threshold point of the modified Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specificity of 56%. The PPV was 89.3% and the NPV was 42.4%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded a 94.5% sensitivity and an 88% specificity. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modified Alvarado and RIPASA scoring systems, respectively. The negative appendectomy rate decreased significantly, from 18.4% to 10.7% for the modified Alvarado, and to 2.2% for the RIPASA scoring system, which was a significant difference (P<0.001) for both scoring systems. CONCLUSION: Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specificity than the modified Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations. The RIPASA scoring system is more accurate and specific than the modified Alvarado scoring system for Kuwait population.

Precisión diagnóstica de la escala RIPASA para el diagnóstico de apendicitis aguda: análisis comparativo con la escala de Alvarado modificada / Diagnostic accuracy of the RIPASA Score for the diagnosis of acute appendicitis: comparative analysis with the modified Alvarado Score

Objetivo: Evaluar en forma comparativa la escala de Alvarado modificada y la escala RIPASA, para conocer su utilidad en el diagnóstico de apendicitis aguda en un hospital de tercer nivel de atención del sector salud. Sede: Hospital General de México. Diseño: Estudio prospectivo, transversal, comparativo y observacional. Análisis estadístico: Medidas de tendencia central, análisis para pruebas diagnósticas (sensibilidad, especificidad, valores predictivos, likelihood ratio o coeficiente de probabilidad) y curva ROC. Pacientes y métodos: De acuerdo al cálculo de tamaño de muestra se estudiaron 70 pacientes, que ingresaron al Servicio de Urgencias del Hospital General de México con síndrome doloroso abdominal sugestivo de apendicitis aguda, se les realizaron estudios de laboratorio y gabinete. Aplicando en forma simultánea las escalas de Alvarado modificada y la RIPASA. Se anotaron hallazgos clínicos, quirúrgicos e histopatológicos del apéndice. Resultados: La escala de Alvarado presentó una sensibilidad de 89.5% y especificidad de 69.2%, la RIPASA presentó una sensibilidad de 91.2% y especificidad de 84.6%. El área bajo la curva ROC de la escala RIPASA fue de 0.93, superior a la de Alvarado de 0.89. Si la decisión quirúrgica se hubiera realizado con base en la escala de Alvarado, las apendicectomías negativas se hubieran presentado en 18.3% pacientes, y con RIPASA disminuirían a 15.7%. Conclusiones: Ambas escalas presentaron buena sensibilidad para el diagnóstico de apendicitis aguda. La escala RIPASA presentó mejor especificidad y valores predictivos, con menor probabilidad de apendicectomías negativas. La escala RIPASA presenta mayor exactitud diagnóstica que la de Alvarado.

Objective: To assess comparatively the Modified Alvarado and the RIPASA scores, to know their usefulness in the diagnosis of acute appendicitis in a third level health care hospital. Setting: General Hospital of Mexico. Design: Prospective, cross-sectional, comparative, and observational study. Statistical analysis: Central Tendency Measures, analyses for diagnostic tests (specificity, sensitivity, predictive values, likelihood ratio) and ROC curve. Patients and methods: According to the established sample size, we studied 70 patients that were admitted at the Emergency Ward of the General Hospital of Mexico, with abdominal pain syndrome suggestive of acute appendicitis. Laboratory and imaging studies were performed. The modified Alvarado and RIPASA scores were applied simultaneously. Clinical, surgical, and histopathological findings were recorded. Results: The Alvarado score presented a sensitivity of 89.5% and a specificity of 69.2%, whereas RIPASA presented a sensitivity of 91.2% and specificity of 84.6%. The area under the ROC curve for the RIPASA score was 0.93, higher than that of the Alvarado with 0.89. If surgical decision had been based on the Alvarado score, negative appendicectomies would have been encountered in 18.3% of patients, and with RIPASA they would have diminished to 15.7%. Conclusions: Both scores presented a good sensitivity for the diagnosis of acute appendicitis. RIPASA presented better specificity and predictive values, with a lower likelihood of negative appendicectomies. The RIPASA score had a better diagnostic accuracy than the Alvarado score.