Abstract

Background: Appendicitis is one of the most common gastrointestinal emergencies and appendicectomy is one of the most commonly performed abdominal emergency. Less studies have been cited in the literature regarding the diagnosis of acute appendicitis based on the two (Alvarado and RIPASA) scoring systems.

Aims and Objectives: To assess the reliability & practical applicability of the widely used Alvarado and RIPASA scoring system in patients with suspected acute appendicitis.

Materials and Methods: 60 patients fulfilling the inclusion criteria were included in the study. The study was carried out at DVVPF’s Medical College and hospital, Ahmednagar between February 1,2018 to July 1, 2019.  Parameters for the study were Alvarado score, RIPASA score and histopathology findings. On arrival of patients in casualty/ surgery department with clinical suspicion of acute appendicitis, both the Alvarado and RIPASA parameters were applied to them. The surgeon who admitted the patient and had taken decision for appendicectomy was asked to fulfil the Alvarado and the RIPASA parameter card using the tick () marks. After the procedure of appendicectomy was over Alvarado and RIPASA score was calculated for the same patient for comparison.

Results: The most common age group amongst our study population was 21 to 30 years (51.67%) followed by 31 to 40 years (20.00%). According to Alvarado scoring system,the most common symptom was Nausea & vomiting (86.67%), followed by pain migration to RIF (65%) and anorexia (60%). Most common sign was RIF tenderness (100%), followed by rebound tenderness (70%) and fever (18.33%). Raised WBC count was found in 68.33% patients and shift to left in 55% patients. According to RIPASA scoring system, 54 (90%) patients had age ≤39.9 years and 6 (10%) patients had age > 40 years. 59 (98.33%) patients had right iliac fossa pain, 39 (65%) patients pain migration to right iliac fossa was present, 34 (56.67%) patients had anorexia and nausea and vomiting in 51 (85%) patients. Duration of symptoms less than 48 hours was present in 51 (85%) patients, while 9 (15%) patients had duration of symptoms greater than 48 hours. All 60 (100%) patients had RIF tenderness present, while guarding was present in 29 (48.33) patients. 42 (70%) patients had rebound tenderness present, 12 (20%) patients had Rovsing’s sign present and fever was present in 11 (18.33%) patients. 41 (68.33%) patients had raised WBC and 56 (93.33%) patients had negative urinalysis. There was no foreign nationals. In our study, 38 (63.33%) patients had Alvarado score ≥7 and 22 (36.67%) patients had Alvarado score < 7. In RIPASA scoring system, 55 (91.67%) patients had score ≥7.5 and 5 (8.33%) patients has score < 7.5. The difference was statistically significant with Chi-square value 13.811 and p value 0.0002. With RIPASA score ≥7.5 sensitivity was 96% (CI 86.29-99.51), while Alvarado score ≥7 had sensitivity 68% (CI 53.30-80.48).Diagnostic accuracy of Alvarado scoring system was 66.67% as compared with RIPASA scoring system which was found to be 85.00%.

Conclusion: The alternative of having additional parameters makes the RIPASA score more flexible and adaptable to different geographical conditions. Looking in terms of healthcare cost savings, the use of RIPASA score may help to reduce inpatient admissions which can be avoided as well as costly radiological imaging investigations.

Keywords: Alvarado, RIPASA, scoring system, acute appendicitis.