Alvarado Vs Ripasa Scores in Diagnosing Acute Appendicitis in A Tertiary Care Centre

Background: Acute appendicitis is a common surgical emergency and early diagnosis is crucial to prevent complications such as perforation and the formation of an appendix abscess. Development of clinical scoring systems: Improves diagnostic accuracy, especially in limited resource settings. The Alvarado and RIPASA scores are extensively utilized. Evaluating their performance enhances clinical decision-making and minimizes superfluous appendectomies. The aim is to compare the diagnostic accuracy of Alvarado scoring system versus RIPASA scoring system in diagnosing acute appendicitis. Material and Methods: This is a prospective observational study carried out in Department of General Surgery for 12 months with a 65 patients with a clinical suspicion of acute appendicitis. Demographic and clinical data were collected after obtaining informed consent. Alvarado and RIPASA scores were used to assess each patient. Patients were categorized as 'high risk' or 'low risk' by the use of predetermined cut-off values (Alvarado ≥7 and RIPASA ≥7.5). Operative interventions were performed in all the patients as per clinical decision making. Intraoperative diagnosis and histopathology analysis of the postoperative specimen were taken as the gold standards to confirm the diagnosis of appendicitis. The sensitivity, the specificity, the positive predictive value (PPV), the negative predictive value (NPV) and the diagnostic accuracy of both scoring systems were analysed and compared. Results: On histopathology, the majority of the 65 included had acute appendicitis. Moderate sensitivity and specificity were seen with the Alvarado score, in that it was able to detect a significant number of actual cases, but was not able to detect some early or atypical presentations. In contrast, the RIPASA score displayed greater sensitivity and recognized more true-positive patients and showed good overall diagnostic accuracy. Both the positive predictive value (PPV) and Negative predictive value (NPV) were high for RIPASA, indicating a more reliable classification for different clinical presentations. Conclusion: The Alvarado score was not as sensitive, specific or accurate as the RIPASA scoring system for suspected acute appendicitis. Using RIPASA along with traditional evaluation can provide a better diagnostic accuracy and reduce the number of negative appendectomy.

Keywords: Acute appendicitis, Alvarado score, Diagnostic accuracy, RIPASA score.