COMPARISON OF DIAGNOSTIC ACCURACY OF ALVARADO SCORE AND RIPASA SCORING SYSTEM IN DIAGNOSIS OF ACUTE APPENDICITIS

Authors

  • Aamna Mukhtar Combined Military Hospital CMH
  • Bilal Saeed Combined Military Hospital (CMH), Rawalpindi, Pakistan
  • Muhammad Awais Combined Military Hospital (CMH), Rawalpindi, Pakistan
  • Jawad Shahid Combined Military Hospital (CMH), Rawalpindi, Pakistan
  • Muhammad Salman Faiz Combined Military Hospital (CMH), Rawalpindi, Pakistan
  • Meezan Jalil Combined Military Hospital (CMH), Rawalpindi, Pakistan

DOI:

https://doi.org/10.69723/njms.03.04.0429

Abstract

BACKGROUND : Acute appendicitis is one of the most common surgical emergencies, frequently presenting with abdominal pain, often located in the right lower quadrant (RLQ). Despite its prevalence, diagnosing acute appendicitis remains challenging due to the variability in clinical presentation and the anatomical heterogeneity of the appendix.

OBJECTIVE : To compare the diagnostic accuracy of ALVARADO and RIPASA scoring systems in the diagnosis of acute appendicitis, keeping histopathology as the standard reference.

METHODOLOGY :  This cross-sectional comparative validation study was conducted at CMH Rawalpindi from July 1, 2023, to December 31, 2023, and included 61 patients who met the inclusion criteria. ALVARADO and RIPASA scores were calculated pre-operatively in patients following laparoscopic appendectomy. The removed appendix was then sent for histopathological diagnosis. A 2x2 table was drawn for calculating diagnostic accuracy parameters. Data was analyzed by the Statistical Package for Social Sciences version 20.

RESULTS : In comparison to histopathological assessment, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of RIPASA score to diagnose acute appendicitis was 91.80%, 95.65%, 80.00%, 93.62%, and 85.71% while for ALVARADO score these values were 85.25%, 91.30%, 66.67%, 89.36%, and 71.43%, respectively.

CONCLUSION :  The accuracy of the RIPASA scoring system is higher as compared to the ALVARADO score in diagnosing acute appendicitis.

KEYWORDS : ALVARADO score, Appendicitis, Appendectomy, Diagnostic accuracy, RIPASA score

References

Constantin M, Petrescu L, Mătanie C, Vrancianu CO, Niculescu AG, Andronic O, et al. The vermiform appendix and its pathologies. Cancers. 2023;15(15):3872. https://doi,org10.3390/cancers15153872.

Peeters T, Martens S, D'Onofrio V, Stappers MH, van der Hilst JC, Houben B, et al. An observational study of innate immune responses in patients with acute appendicitis. Sci Rep. 2020;10(1):17352.

https://doi.org/10.1038/s41598-020-73798-3.

Nakahara K, Nakane S, Ishii K, Ikeda T, Ando Y. Gut microbiota of Parkinson's disease in an appendectomy cohort: a preliminary study. Sci Rep. 2023;13(1):2210. https://doi.org/10.1038/s41598-023-29219-2.

Chhetri S, Al Mamari AH, Al Awfi MM, Al Khaldi NHN, Abed NM, Pandak N, et al. Enterobius vermicularis related acute appendicitis: a case report and review of the literature. Infect Dis Rep. 2023;15(4):417-424.

https://doi.org/10.3390/idr15040042.

Tran N, Emuakhagbon VS, Baker BT, Huerta S. Re-assessing the role of the fecalith in acute appendicitis in adults: case report, case series, and literature review. J Surg Case Rep. 2021;2021(1): rjaa543.

https://doi.org/10.1093/jscr/rjaa543.

Echevarria S, Rauf F, Hussain N, Zaka H, Farwa UE, Ahsan N, et al. Typical and atypical presentations of appendicitis and their implications for diagnosis and treatment: a literature review. Cureus. 2023;15(4): e37024.

https://doi.org/10.7759/cureus.37024.

Podda M, Pisanu A, Sartelli M, Coccolini F, Damaskos D, Augustin G, et al. Diagnosis of acute appendicitis based on clinical scores: is it a myth or reality? Acta Biomed. 2021;92(4):e2021231.

https://doi.org/10.23750/abm.v92i4.11666.

Ghali MS, Hasan S, Al-Yahri O, Mansor S, Al-Tarakji M, Obaid M, et al. Adult appendicitis score versus Alvarado score: A comparative study in the diagnosis of acute appendicitis. Surg Open Sci. 2023; 14:96-102. https://doi.org/10.1016/j.sopen.2023.07.007.

Henriksen SR, Christophersen C, Rosenberg J, Fonnes S. Varying negative appendectomy rates after laparoscopic appendectomy: a systematic review and meta-analysis. Langenbecks Arch Surg. 2023;408(1):205.

https://doi.org/10.1007/s00423-023-02935-z.

Crocker C, Akl M, Abdolell M, Kamali M, Costa AF. Ultrasound and CT in the diagnosis of appendicitis: accuracy with consideration of indeterminate examinations according to STARD guidelines. Am J Roentgenol. 2020;215(3):639-644. https://doi.org/10.2214/AJR.19.22370.

Dooki ME, Nezhadan M, Mehrabani S, Osia S, Hadipoor A, Hajiahmadi M, et al. Diagnostic accuracy of laboratory markers for diagnosis of acute appendicitis in children. Wien Med Wochenschr. 2022;172(13-14):303-307.

https://doi.org/10.1007/s10354-021-00898-8.

Butt MQ, Chatha SS, Ghumman AQ, Farooq M. RIPASA score: a new diagnostic score for diagnosis of acute appendicitis. J Coll Physicians Surg Pak. 2014;24(12):894-897.

Al-Tarakji M, Zarour A, Singh R, Ghali MS. The role of Alvarado score in predicting acute appendicitis and its severity in correlation to histopathology: a retrospective study in a Qatar population. Cureus. 2022;14(7): e26902.

https://doi.org/10.7759/cureus.26902.

Nanjundaiah N, Mohammed A, Shanbhag V, Ashfaque K, Priya SA. A comparative study of RIPASA score and ALVARADO score in the diagnosis of acute appendicitis. J Clin Diagn Res. 2014;8(11):NC03-NC05.

https://doi.org/10.7860/JCDR/2014/9055.5170.

Gebre Selassie H, Tekle Selassie H, Ashebir D. Pattern and outcome of acute appendicitis: observational prospective study from a teaching hospital, Addis Ababa, Ethiopia. Open Access Emerg Med. 2021; 13:265-271.

https://doi.org/10.2147/OAEM.S315228.

Moris D, Paulson EK, Pappas TN. Diagnosis and management of acute appendicitis in adults: a review. JAMA. 2021;326(22):2299-2311. https://doi.org/10.1001/jama.2021.20502.

Suleimanov V, Alhanabi FH, Al Saeed FH, Aldrazi HA, Fagir HA. A rare complication of perforated appendicitis: a case of necrotizing fasciitis. Cureus. 2022;14(9):e29679. https://doi.org/10.7759/cureus.29679.

Potey K, Kandi A, Jadhav S, Gowda V. Study of outcomes of perforated appendicitis in adults: a prospective cohort study. Ann Med Surg (Lond). 2023;85(4):694-700. https://doi.org/10.1097/MS9.0000000000000277.

Chaochankit W, Boocha A, Samphao S. Negative appendectomy rate in patients diagnosed with acute appendicitis. BMC Surg. 2022;22(1):404.

https://doi.org/10.1186/s12893-022-01852-0.

Noureldin K, Hatim Ali AA, Issa M, Shah H, Ayantunde B, Ayantunde A. Negative appendicectomy rate: incidence and predictors. Cureus. 2022;14(1): e21489. https://doi.org/10.7759/cureus.21489.

Stein GY, Rath-Wolfson L, Zeidman A, Atar E, Marcus O, Joubran S, et al. Sex differences in the epidemiology, seasonal variation, and trends in the management of patients with acute appendicitis. Langenbecks Arch Surg. 2012;397(7):1087-1092. https://doi.org/10.1007/s00423-012-0958-0.

Akbar I, Shehzad JA, Ali S. Diagnostic accuracy of Ripasa score. J Ayub Med Coll Abbottabad. 2019;31(3):411-414.

Majid M, Maqsood R, Ali M, Malhi MAA, Hussain Z, Abbasi MH. Comparison of Alvarado Score and RIPASA score in the accurate diagnosis of acute appendicitis in combined military hospital Rawalpindi. Pak Armed Forces Med J. 2021;71(5):1519-1523. https://doi.org/10.51253/pafmj.v71i5.3596.

Aslam I, Mehmood R, Rafi Y, Mukhtar Z, Gondal KM. Diagnostic accuracy of Alvarado and Ripasa scoring systems for diagnosis of acute appendicitis taking histopathology as gold standard. Pak J Med Health Sci. 2020;14(03):797-801.

Published

12/31/2024

How to Cite

COMPARISON OF DIAGNOSTIC ACCURACY OF ALVARADO SCORE AND RIPASA SCORING SYSTEM IN DIAGNOSIS OF ACUTE APPENDICITIS. (2024). NORTHWEST JOURNAL OF MEDICAL SCIENCES, 3(4), 13-18. https://doi.org/10.69723/njms.03.04.0429