Background: Acute appendicitis is one of the commonest surgical emergencies. Different scoring systems are postulated to arrive at a diagnosis. A new scoring system named RIPASA scoring system was developed to aid in the diagnosis of acute appendicitis in the Asian countries. We have prospectively compared diagnostic accuracy of RIPASA scoring and modified Alvarado scoring system.

Materials & Methods: This observational study was done in Rajah Muthiah Medical College and Research Institute between June 2015 and August 2016 in patients with clinical diagnosis of acute appendicitis and undergoing appendicectomy were included in the study. After obtaining their consent study were conducted. Both Alvarado score and RIPASA score were calculated for all the patients. The operative findings and postoperative histopathology report were compared with the two scoring systems. Receiver operating curve (ROC), sensitivity, specificity & diagnostic accuracy were calculated.

Results: One hundred and fifty patients satisfying inclusion and exclusion criteria were analysed. At optimal cut-off point of 7.5 derived from ROC curve for RIPASA, the sensitivity & specificity was 99.25% and 55 % respectively. At the cut-off thresh-hold of 7.0 derived from ROC curve for modified Alvarado score the sensitivity and specificity is 78.46% and 59.09% respectively. The diagnostic accuracy of RIPASA was 5.4% better than Modified Alvarado score.

Keywords: Acute Appendicitis, Ripasa Score, Histopathology. ROC Curve, Specificity and Alvarado Scoring System.

1. Chong CF, Thien A, Mackie AJ, Tin AS, Tripathi S, Ahmad MA, Tan LT, Ang SH, Telisinghe PU. Comparison of RIPASA and ALVARADO score for the diagnosis of acute appendicitis. Singapore Med J. 2011; 52(5):340-5
2. Peterson MC, Holbrook JH, hales D smith NL, staker LV contribution of history, physical examination and laboratory investigation in making medical diagnosis. West j med. 1992;156(2):163-5.
3. Lau WY, Ho YC, chu KW, Yeung C. Leucocyte count and neutrophil percentage in appendicectomy for suspected appendicitis. Aust N Z J Surg. 1989;59(5):395-8.
4. Al-Ajerami Y. Sensitivity and specificity of ultrasound in diagnosis of acute appendicitis. East mediterr Health J. 2012;18(1):66-9.
5. Krajewski S, Brown J, Phang PT, Raval M, Brown CJ. Impact of Computed tomography of the abdomen on clinical outcome in patient with right lower quadrant pain: a meta-analysis.Can J Surg. 2011; 54(1):43-53.
6. Ozao-choy J, Kim U, Menes TS. Incidental finding on computed tomography scans for acute appendicitis: prevalence, costs and outcome. Am Surg. 2011; 77:1502-9.
7. Petrosyan M, Estrada J, Chan S, Somers S, Yacoub WN, Kelso RL, Mason RJ. CT scan in patient with suspected appendicitis: clinical implication for the acute care surgeon. Eur Surg Res. 2088;40(2):211-9.
8. Anderson RE. Resolving appendicitis is common: further evidence. Ann Surg. 2008;247(3):553.
9. Livingston EH, Woodward WA, Sarosi GA, Haley RW. Disconnect between incidence of nonperforated appendicitis: Implications for pathophysiology and management. Ann Surg.2007;245(6)886-92.
10. Alvarado A. A practical score for early diagnosis of acute appendicitis. Ann Emerg Med 1986;15:557-64.
11. Chong CF, adi MIW, Thien A, Suyoi A, Mackie AJ, Tin A S et al. Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of diagnosis of acute appendicitis. Singapore Med J. 2010;51:2205.
12. Andreou P, Blain S, BoulayCEH. A histopathology study of appendix at atopsy and after surgical resection. Histopathology.1990;17:427-31.

Ashwin Muthukumar

Post Graduate, Department of General Surgery,

Rajah Muthiah Medical College, Chidambaram