Diagnostic Importance of Alvarado and RIPASA Score in Acute Appendicitis

Introduction: One of the most common surgical emergencies encountered in the day to day practice both in developed and developing countries in the world is acute appendicitis. The incidence may range from 13% to 77%. The diagnosis is purely based on clinical history, examination and ultrasonography. Many studies are available about the diagnostic methods used for acute appendicitis in western population. Only very few studies were seen about the accuracy of scoring system in Indian population. Aim: To compare the accuracy of Alvarado and RIPASA score in diagnosing appendicitis. Materials and Methods: This was a prospective study conducted at Melmaruvathur Adhiparashakthi Medical College and Hospital in the Department of Surgery from March 2014 to January 2015. About 105 patients with symptoms and signs of acute appendicitis were subjected to Alvarado and RIPASA scoring chart and taken for emergency appendicectomy. The diagnostic accuracy of the scoring system was were derived. Results: In this study, 75% of patients were of <40 years of age and 57 (54.29%) patients were female. The most common presenting symptoms in our study were right iliac fossa pain (100%), and sign was rebound tenderness (100%). Histopathologically, about 81.8% of cases were diagnosed as appendicitis. According to Alvarado score <7 and RIPASA score <7.5 80 (76.19%) and 93 (88.57%) patients were diagnosed as appendicitis. The Alvarado score had increased specificity, positive predictive value, and positive likelihood ratio than RIPASA score. The sensitivity and negative predictive value were more for RIPASA score. According to Chi-square test, both Alvarado and RIPASA score was found to be statistically significant. Conclusion: The best method to diagnose the acute appendicitis is by proper clinical examination. Both Alvarado and RIPASA score was statistically significant. But by using RIPASA score the mortality and morbidity due to appendicitis can be reduced.