Abstract
Acute appendicitis is the most common cause of abdominal emergency in both developed and developing countries. Several scoring systems have been developed in order to aid the decision-making process to reach diagnosis of acute appendicitis in the quickest and cheapest way. Of which the Alvarado and the Modified Alvarado Scoring Systems (MASS) are the two most commonly used scoring systems worldwide. In a recent study conducted in Brunei, Darussalam from Nov 2008 to April 2009 hypothesized a new scoring system named as Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring. The study claimed that this scoring system is having much more sensitivity, specificity, positive and negative predictive value than other scoring system. Therefore, present study has tried to assess the diagnostic accuracy of RIPASA scoring system among the patients undergoing emergency appendicectomy in a rural hospital from West Bengal. A total of 88 patients including 42 males and 46 females admitted for emergency appendicectomy during 2015-2016 have been considered for present study. Before commencement of the study the purpose of the study and consent has been obtained from the studied patients. Clinical investigation and histopathological report also compared with the RIPASA score. Data revealed that RIPASA has Sensitivity of 97.14%, Specificity of 77.78%, Positive Predictive Value (PPV) of 94.44%, Negative Predictive Value (NPV) of 87.5% and Diagnostic Accuracy of 93.18%. This result corroborated with other studies from different parts of the world.
So it can be recommended from the present study that for quick and early diagnosis for acute appendicitis and to avoid the negative appendicectomy as much as possible and reduce the morbidity and mortality and economic burden related to negative appendicectomy RIPASA score can be used as a much more advanced scoring system than MASS with higher rate of diagnostic accuracy.
Keywords: RIPASA, Acute Appendicitis, MASS, Histopathology.
References
- Pal KM, Khan A. Appendicitis: a continuing challenge. J Pak Med Anoc 1998; 48:189-92.
- Terasawa T, Blackmore CC, Bent S, Kohlwes RJ. Systemic Review: CT and USG to detect acute appendicitis in adults & adolescents. Am Intern Med 2004; 141: 537-546.
- Livingstone EH, Woodward WA, Sarosi GA, Haley RW. Disconnect between incidence non perforated & perforated appendicitis: implications for pathology and management. Am Surg 2007; 245: 886-892.
- Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986; 15: 557-564.
- Peyvasteh M, Askarpour S, Javaherizadeh H, Besharati S. Modified Alvarado score in children with diagnosis of appendicitis. Arq Brasil Cirurgia Dig (São Paulo) 2017; 30 (1): 51-52.
- Shuaib A, Shuaib A, Fakhra Z, Marafi B, Alsharaf K, Behbehani A. Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis. World J Emerg Med 2017; 8 (4):276-280.
- Kalan M, Rich AJ, Talbot DR, Canlitie WJ. Evaluation of modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Surg Eng 1994; 76:418-419.
- Barman MK, Chanak M, Das K, Mukherjee K. Use and relevance of modified alvarado scoring system in diagnosis of acute appendicitis: A cross sectional study from West Bengal, India. Int J Adv Med 2019; 6(2): 346-350.
- Barman MK, Das K, Mukherjee K. A Study on Comparision of Diagnostic Efficiency between Modified Alvarado Score and Graded Compression Ultrasonography in the Case of Acute Appendicitis. Int J Cur Res Rev 2018; 10(9): 22-26.
- Chong CF CF, Adi Miw, Thien A, Mackie AJ, Tin AS, Tripathi S et al. Development of RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis. Singapore Med J 2010; 51(3): 220-225.
- Chang CF, Thien A, Mackie A, Tin AS, Tripathi S, Ahmed MA et al. Evaluation of the RIPASA score: a new scoring system for the diagnosis of acute appendicitis. Brunei Int Med J 2010; 6(1): 17-26.
- Al-Hashemy AM, Seleem MI. Appraisal of the modified Alvarado Score for acute appendicits in adults. Saudi Med J 2004; 25(9):1229-1231.
- Kanumba ES, Mabula JB, Rambau P, Chalya PL. Modified Alvarado scoring system as a diagnostic tool for acute appendicitis at Bugando Medical Centre, Mwanza, Tanzania. BMC Surg 2011; 11(1): 4.
- Nasiri S, Mohebbi F, Sodagari N, Hedayat A. Diagnostic values of ultrasound and the Modified Alvarado Scoring System in acute appendicitis. Int J Emerg Med. 2012; 5(1): 26.
- Chong CF, Thien A, Mackie AJ, Tin AS, Tripathi S, Ahmad MA, et al. Comparison of RIPASA and Alvarado scores for the diagnosis of acute appendicitis. Singapore Med J 2011; 52(5): 340-345.
- Alnjadat I, Abdallah B. Alvarado versus RIPASA score in diagnosing acute appendicitis. Rawal Med J 2013; 38(2):147-51.
- Altman DG, Bland JM. Diagnostic tests: Sensitivity and Specificity. BMJ 1994; 308 (6943):1552.
- Erdem H, Çetinkünar S, Daş K, et al. Alvarado, Eskelinen, Ohhmann and Raja Isteri Pengiran Anak Saleha Appendicitis scores for diagnosis of acute appendicitis. World J Gastroenterol 2013; 19 (47): 9057–9062.
Corresponding Author
Dr Malay Kumar Barman
Associate Professor, Department of General Surgery, North Bengal Medical College, Darjeeling, West Bengal, India