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The RIPASA score is sensitive and specific for the diagnosis of acute appendicitis in a western population

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Aim: The definitive diagnosis of acute appendicitis (AA) requires histopathological examination. Various clinical diagnostic scoring systems attempt to reduce negative appendectomy rates. The most commonly used in Western Europe and the USA is the Alvarado score. The Raja Isteri Pengiran Anak Saleha appendicitis (RIPASA) score achieves better sensitivity and specificity in Asian and Middle Eastern populations. We aimed to determine the diagnostic accuracy of the RIPASA score in Irish patients with AA. Methods: All patients who presented to our institution with right iliac fossa pain and clinically suspected AA between January 1 and December 31, 2015, were indentified from our hospital inpatient enquiry database and retrospectively studied. Operating theatre records and histology reports confirmed those who underwent a non-elective operative procedure and the presence or absence of AA. SPSS version 22 was used for statistical analysis. Standard deviation is provided where appropriate. Results: Two hundred eight patients were included in the study (106/51% male, mean age 22.7 ± 9.2 years). One hundred thirty-five (64.9%) had histologically confirmed AA (mean symptom duration = 36.19 ± 15.90 h). At a score ≥7.5, the previously determined score most likely associated with AA in Eastern populations, the RIPASA scoring system demonstrated a sensitivity of 85.39%, specificity of 69.86%, positive predictive value of 84.06%, negative predictive value of 72.86% and diagnostic accuracy of 80% in our cohort. Conclusion: The RIPASA score is a useful tool to aid in the diagnosis of acute appendicitis in the Irish population. A score of ≥7.5 provides sensitivity and specificity exceeding that previously documented for the Alvarado score in Western populations. WHAT DOES THIS PAPER ADD TO THE LITERATURE?: This is the first study evaluating the utility of the RIPASA score in predicting acute appendicitis in a Western population. At a value of 7.5, a cut-off score suggestive of appendicitis in the Eastern population, RIPASA demonstrated a high-sensitivity, specificity, positive predictive value and diagnostic accuracy in our cohort and was more accurate than the commonly used Alvarado score.
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ORIGINAL ARTICLE
The RIPASA score is sensitive and specific for the diagnosis
of acute appendicitis in a western population
Muhammad Usman Malik
1
&Tara M. Connelly
2
&Faisal Awan
1
&Frederik Pretorius
1
&
Constantino Fiuza-Castineira
1
&Osama El Faedy
1
&Paul Balfe
1
Accepted: 18 November 2016 / Published online: 15 December 2016
#Springer-Verlag Berlin Heidelberg 2016
Abstract
Aim The definitive diagnosis of acute appendicitis (AA) re-
quires histopathological examination. Various clinical diag-
nostic scoring systems attempt to reduce negative appendec-
tomy rates. The most commonly used in Western Europe and
the USA is the Alvarado score. The Raja Isteri Pengiran Anak
Saleha appendicitis (RIPASA) score achieves better sensitivi-
ty and specificity in Asian and Middle Eastern populations.
We aimed to determine the diagnostic accuracy of the
RIPASA score in Irish patients with AA.
Methods All patients who presented to our institution with
right iliac fossa pain and clinically suspected AA between
January 1 and December 31, 2015, were indentified from
our hospital inpatient enquiry database and retrospectively
studied. Operating theatre records and histology reports con-
firmed those who underwent a non-elective operative proce-
dure and the presence or absence of AA. SPSS version 22 was
used for statistical analysis. Standard deviation is provided
where appropriate.
Results Two hundred eight patients were included in the study
(106/51% male, mean age 22.7 ± 9.2 years). One hundred
thirty-five (64.9%) had histologically confirmed AA (mean
symptom duration = 36.19 ± 15.90 h). At a score 7.5, the
previously determined score most likely associated with AA
in Eastern populations, the RIPASA scoring system demon-
strated a sensitivity of 85.39%, specificity of 69.86%, positive
predictive value of 84.06%, negative predictive value of
72.86% and diagnostic accuracy of 80% in our cohort.
Conclusion The RIPASA score is a useful tool to aid in the
diagnosis of acute appendicitis in the Irish population. A score
of 7.5 provides sensitivity and specificity exceeding that pre-
viously documented for the Alvarado score in Western
populations.
What does this paper add to the literature? This is the first
study evaluating the utility of the RIPASA score in predicting
acute appendicitis in a Western population. At a value of 7.5, a
cut-off score suggestive of appendicitis in the Eastern popula-
tion, RIPASA demonstrated a high-sensitivity, specificity,
positive predictive value and diagnostic accuracy in our cohort
and was more accurate than the commonly used Alvarado
score.
Keywords RIPASA score .Alvarado score .Acute
appendicitis .Histopathology .Raja Isteri Pengiran Anak
Saleha appendicitis score
Introduction
Acute appendicitis (AA) is the most common condition re-
quiring emergency surgical intervention [1,2]. Incidence in
Eastern and Western populations is similar, with a lifetime risk
of approximately 6 and 8%, respectively [3,4]. Appendicular
perforation is found in up to 20% of cases [5], and increases
mortality from approximately .00002 to 3%, and morbidity
from 3 to 47% [6,7]. This risk is increased with delays in
diagnosis and intervention [8]. Thus, the appendix is frequent-
ly excised even in cases where even a low index of suspicion
is held, leading to unnecessary surgery in up to 40% of pa-
tients [9].
*Tara M. Connelly
tarconnelly@rcsi.ie
1
Department of Surgery, St. Lukes Hospital, Kilkenny, Ireland
2
Department of Surgery, University Hospital Waterford,
Waterford, Ireland
Int J Colorectal Dis (2017) 32:491497
DOI 10.1007/s00384-016-2713-4
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Malik et al. reported that the included patients had a mean symptom duration of 36.19±15.90 h and a high incidence of leukocytosis, similar to our findings [10] . This consistency across different populations highlights the reliability of leukocytosis as an indicator of acute appendicitis. ...
... No inflammation was detected in nine cases. These results align with those of Malik et al. who reported a high incidence of histologically confirmed acute appendicitis in their cohort [10] . Damburacı et al. found that 84% of cases were diagnosed with acute appendicitis based on histopathological examination, with a negative appendectomy rate of 14% [7] . ...
... Por ejemplo, la puntuación RIPASA ha mostrado mayor sensibilidad y especificidad que la puntuación de Alvarado en poblaciones de Asia y Oriente Medio. (22) Manejo La apendicitis no perforada, también conocida como apendicitis simple o apendicitis no complicada, se refiere a la apendicitis aguda que se presenta sin signos clínicos o radiográficos de perforación (por ejemplo, masa inflamatoria, flemon o absceso). Aproximadamente el 80 % de las apendicitis no están perforadas al momento de la presentación. ...
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La apendicitis, que es la inflamación del apéndice vermiforme vestigial, representa una de las causas más habituales del abdomen agudo y una de las razones más recurrentes para realizar cirugías abdominales de emergencia a nivel mundial. El análisis de las personas con sospecha de apendicitis se enfoca en identificar de manera temprana a quienes padecen apendicitis aguda mientras se procura reducir al mínimo la cantidad de cirugías laparoscópicas o laparotómicas innecesarias. Un diagnóstico erróneo de apendicitis, particularmente si ya se encuentra perforada, puede conllevar resultados severamente negativos para el paciente, mientras que las cirugías no terapéuticas generan morbilidad sin abordar la causa subyacente. Por más de cien años, la apendicectomía abierta era el tratamiento estándar para la apendicitis. Hoy en día, las estrategias actuales son más complejas y refinadas: la apendicectomía laparoscópica ahora supera a la abierta en frecuencia, algunos pacientes con apendicitis perforada pueden beneficiarse al comenzar con tratamiento antibiótico preliminar seguido de apendicectomía diferida, y se han realizado ensayos que indican que tratar la apendicitis no complicada solo con antibióticos podría ser viable.
... There has been no single study done in Ethiopia to assess the RIPASA scoring system. A study done in Ireland reported that the diagnostic accuracy of the RIPASA score was 80% at a 95% confidence interval and a 5% margin of error [11]. The sample size was calculated using Epi-Info and is 246. ...
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Background Acute appendicitis is the most common surgical emergency in Ethiopian clinical practice. Although a multitude of scoring systems have been used in clinical practice, none have been universally validated. The purpose of this study was to validate the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system in the Ethiopian context. Methods A total of 315 consecutive patients who presented with a presumptive diagnosis of acute appendicitis and were planned to undergo appendectomy were studied. All the studied patients had diagnostic sonography and underwent the RIPASA scoring system. The sensitivity, specificity, positive predictive value, and negative predictive value of RIPASA and ultrasound results with intraoperative gross examinations. Results The mean age of the participants was 27.4 ± 11.5 years, with a male-to-female ratio of 1.6:1. The concordance between ultrasound and RIPASA for the diagnosis of acute appendicitis was 93.6%. The sensitivity, specificity, positive predictive value, and negative predictive value of RIPASA were 96.2%, 30.8%, 93.9%, and 42.1%, respectively. Similarly, the sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound were 95.3%, 27.8%, 95.6%, and 26.3%, respectively. White cell count and RIPASA scores were weakly correlated with intraoperative stages of acute appendicitis, r(313) = 0.18, p = 0.001, and r(313) = 0.129, p = 0.022, respectively. The rate of a negative appendectomy was 6%. Conclusion RIPASA and ultrasound had equivalent performance in the diagnosis of acute appendicitis. In both cases, the rate of negative appendectomy was low enough to validate RIPASA for clinical practice in low-income institutions where sonographic diagnosis by a conventionally trained radiologist is not available.
... The most common cause of abdominal surgery worldwide as well as the most common surgical emergency encountered in the emergency department is Acute Appendicitis (AA). Life-time prevalence is around 8% and young age group is the most commonly effected (10-30 years old) 1,2 . As the most common disease seen by surgeons, AA has varied presentation, ranging from clinically evident appendicitis to borderline cases. ...
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Objective: To compare RIPASA scoring system with Alvarado scoring system for diagnosing Appendicitis in terms of Diagnostic Accuracy. Study Design: Prospective Observational Study. Methodology: Patients with appendicitis were enrolled after informed consent. Pregnant females, patients younger than 12 years, duration of pain more than 7 days and patients with established causes of pain other than appendicitis were excluded. RIPASA and Alvarado score were calculated but treating Surgeon was blinded to the scores. Resected specimens were sent for histopathology which was gold standard. Sensitivity, Specificity, Negative and Positive Predictive values and Diagnostic Accuracy were calculated using 2x2 table. Results: A total of 184 patients were included in the study. Mean age was 23.6±8.2 years. A total of 23.9% patients had normal Appendices on Histopathology while 76.1% patients were found to have acutely inflamed appendices. RIPASA score had a sensitivity of 96.42% as compared to 79.28% of Alvarado score. The Diagnostic accuracy of Alvarado Score was found to be 69.56% as while the diagnostic accuracy of RIPASA score was found to be 89.67%. Conclusion: RIPASA Score is superior to Alvarado score in terms of diagnostic accuracy in our population.
... Research conducted in Jordan [23], Kuwait [21], Iran [24], and Turkey [5], together with a multicenter, cross-border study involving Saudi Arabia and Egypt [25], have confirmed the findings of the initial study in the Middle Eastern population. Malik et al. conducted one of the initial assessments of the RIPASA scoring in a Western population in Ireland, following the observation of favorable outcomes in several Eastern investigations [26]. In their retrospective analysis of 208 patients, the researchers achieved an SN of 85.93%, an SP of 69.86%, and a diagnostic accuracy of 80.01%. ...
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Background and objectives Appendicitis is a frequent cause of abdominal pain. Because of the limited availability of imaging services in many medical centers and an urge to reduce the substantial number of unnecessary appendectomies, several clinical diagnostic tools have been constructed. A novel diagnostic tool, referred to as the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score, has been created to assist in identifying acute appendicitis (AA) in Asian nations. The study aimed to assess the correlation between RIPASA scores and the severity of appendicitis as determined by pathological examination. Materials and methods The study was a prospective observational investigation undertaken in the Department of General Surgery at Muslim education society (MES) Medical College Perinthalmanna over 12 months. The study included all patients who had been diagnosed with AA and underwent appendectomy, provided they satisfied both the inclusion and exclusion criteria. An analysis was conducted on a convenience sample of 225 individuals using a prestructured proforma. The RIPASA scores were estimated before their surgery, taking into account their age, gender, symptoms, physical examination findings, and laboratory findings. These scores were subsequently contrasted with the histopathological results obtained after the appendectomy. The individuals were categorized into three groups according to their RIPASA scores. The lower-score category, scores between 4 and 7. The intermediate-score category consists of scores ranging from 7.5 to 11.5, while the higher-score category includes scores of 12 and above. These scores are correlated with the histopathology report (HPR) to determine the presence of appendicitis, perforated appendix, appendicular abscess, or the absence of pathology observed. Results The study population comprised of 137 (60.9%) males and 88 (39.1%) females. Among these, 177 individuals (78.7%) were younger than 40 years, while 48 individuals (21.3%) were older than 40 years. Out of 225 cases, 146 cases were AA (64.9%), 27 (12%) appendicular abscess cases, and 41 (18.2%) appendicular perforation cases. The normal appendix was noted in 11 out of 225 cases in the low-score group. The association between the histopathological report and RIPASA score was found to be statistically highly significant (p=0.000). In the low-score group, there were 14 cases of appendicitis (53.8%), one case of appendicular abscess (3.8%), a total of 11 cases without pathology observed (42.3%), and no reported instances of appendicular perforation. In the intermediate-score category, there were 121 cases of appendicitis (89.6%), 12 cases of appendicular abscess (8.9%), 2 cases of appendicular perforation (1.5%), and no reported cases in the non-pathology category. Among the high-score category, there were 11 cases of appendicitis (17.2%), 14 cases of appendicular abscess (21.9%), 39 cases of appendicular perforation (60.9%), and no reported instances of negative appendectomy. Conclusion The study has shown that the RIPASA scoring system had a high diagnostic efficacy in identifying AA. This scoring system is an effective, dependable, cost-effective, noninvasive, reproducible, and safe diagnostic technique that does not require additional expenses or concerns.
... New diagnostic scoring systems, Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and ALVARADO score, which were developed for the diagnosis of acute appendicitis, were found to have much higher specificity, sensitivity and diagnostic accuracy [6]. The Alvarado scoring system excludes some factors, including as age, gender, symptom duration, and urinalysis but comparatively the RIPASA rating system is simple and includes these factors [7,8]. The Alvarado scoring system, one of the most used scoring systems, has sensitivity and specificity ranges of 53% to 88% and 75% to 80%, respectively [9,10]. ...
... PPV=84.06% and NPV=72.86%. The authors concluded that the efficacy is almost identical to that of the population for which the system was initially constructed [11]. ...
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The purpose of this study is to evaluate the applicability of Alvarado, Appendicitis Inflammatory Response (AIR) and „Raja Isteri Pengiran Anak Saleha Appendicitis “(RIPASA) score in diagnosing acute appendicitis (AA) in our population, as well as the possibility for connection between certain values and the emergence of “adverse events” in relation to laparoscopic appendectomy (LA). We conducted a multicentric, prospective, cohort, clinical study on 75 patients with AA treated with LA. For all the patients, the values and corresponding group of the three scoring systems (Alvarado, AIR and RIPASA) were determined preoperatively. We registered the emergence of intraoperative complications and difficulties, reason for conversion and the presence of complications postoperatively. All the patients with some form of intraoperative complication or difficulties, patients on whom conversion to open approach was performed or patients with any kind of postoperative complication were placed in the group “with adverse events” and the rest in the group “without adverse events”. The RIPASA score had an insignificantly higher sensitivity (sens.=96% at a cut-off ˃7 and sens.=68% at a cut-off ˃12) than Alvarado score (sens.=90.7% at a cut-off ≥7 and sens.=62.7% at a cut-off ≥9) and both had significantly higher sensitivity than AIR score (sens.=40% at a cut-off ≥9). Further analysis showed that there was no association between the emergence of adverse events and the corresponding group of the scoring system. The RIPASA scoring system had the highest sensitivity in our population, The investigated scoring systems Alvarado, AIR and RIPASA could not be used for predicting possible unwanted course in patients with AA treated with LA. Keywords: scoring systems, sensitivity, laparoscopic appendectomy, adverse events.
... After observing positive results from multiple Eastern studies, Malik et al. were among the first to evaluate the RIPASA score in a western population in Ireland. Their retrospective study of 208 patients was able to achieve an 85.93% sensitivity, a 69.86% specificity, and a diagnostic accuracy of 80.01% [22]. ...
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Background The diagnosis of acute appendicitis has remained difficult despite it being one of the most common surgical emergencies in the world. One of the most frequently used scoring systems is the Modified Alvarado Score (MAS). However, the MAS has been known to be less efficient in Asian populations. To overcome this issue, the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score has been specifically developed to improve the diagnosis of acute appendicitis in Asian populations. This study aimed to evaluate the accuracy of the RIPASA score compared to the MAS for the diagnosis of acute appendicitis in a Southeast Asian population keeping histopathology as the gold standard. Methodology The study group comprised 150 patients. Data were collected from each patient using a simple proforma to ascertain both the MAS and the RIPASA score for each patient at the time of presentation. The patients then underwent open appendectomy and histopathology was used as the gold standard to determine the presence or absence of acute appendicitis in the excised specimens. Results The RIPASA score had a sensitivity and specificity of 89.83% and 59.38%, respectively, compared to 64.41% and 53.12%, respectively, for the MAS. Diagnostic accuracy was similarly higher for the RIPASA score at 83.33% versus 62.00% for the MAS. Conclusions The RIPASA score is superior to the MAS for the diagnosis of acute appendicitis. Using the RIPASA score instead of the MAS in Southeast Asian populations can lead to a more accurate and timely clinical diagnosis of patients with suspected acute appendicitis and help improve patient outcomes.
... This results in unnecessary surgery and risk of postoperative complications in upto 40% patients, especially in women of reproductive age. [8] Over time, the regular laboratory investigations have been supplemented with newer clinical scoring systems and imaging modalities like ultrasonography (USG). [9] While this resulted in a drop in the negative appendectomy rates, newer and more robust clinical scoring systems are required to push it even lower. ...
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Background: Appendicitis is a commonly encountered condition in clinical practice. It is a difficult diagnosis and a high rate of negative appendectomy increases complications, morbidity and mortality among patients. Histopathological examination is the modality for definitive diagnosis, which requires patients to undergo appendectomy. This predisposes possibly normal individuals to postoperative complications. Scoring systems for diagnosing appendicitis have been developed and we attempt to validate one such recently developed scoring system, RAMA-AS. Our study also compared RAMA-AS with a more commonly used Alvarado scoring system. Materials and Methods: A prospective observational study of 100 clinically suspected patients of appendicitis was conducted in a tertiary care center. They were given scores according to the RAMA-AS and Alvarado scoring systems. Patient scores according to both scoring systems were subjected to analysis with USG findings. Results: We found a significant association between the RAMA-AS and USG diagnosis with a sensitivity, specificity and positive predictive value of 51.35%, 92.30% and 95% as compared to the Alvarado scoring system, which showed a sensitivity, specificity and positive predictive value of 28.37%, 84.61% and 84%. Conclusions: The incorporation of scoring systems can help in detecting patients with high scores as probable cases of appendicitis. RAMA-AS was found to have a significant association with appendicitis. RAMA-AS showed a better sensitivity, specificity, positive predictive value and negative predictive value than the Alvarado scoring system. But, patients with low scores should utilize other diagnostic modalities to decrease the chances of missing positive cases.
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La apendicitis aguda es una causa común de abdomen agudo en pacientes geriátricos, pero su diagnóstico puede ser desafiante debido a presentaciones atípicas y comorbilidades asociadas. Este estudio compara la efectividad diagnóstica de las escalas de Alvarado y RIPASA en pacientes mayores de 65 años [1]. A través de una revisión sistemática de la literatura y análisis de estudios clínicos, se evaluó la sensibilidad, especificidad y valor predictivo de ambas escalas [2]. Los hallazgos sugieren que la escala RIPASA puede ofrecer una mayor sensibilidad en esta población, mientras que la escala de Alvarado mantiene una alta especificidad [3]. La combinación de ambas herramientas podría mejorar la precisión diagnóstica y reducir las tasas de apendicectomías negativas [4]. Estos resultados tienen implicaciones significativas para la práctica clínica en entornos con recursos limitados y podrían guiar la selección de herramientas de evaluación más adecuadas para pacientes geriátricos [5].
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Introduction: Acute appendicitis is one of the most common surgical emergencies. The RIPAS score has been developed to aid clinical diagnosis of acute appendicitis as high sensitive and specific score system. The aim of our study is to reduce use of CT abdomen in cases of acute appendicitis by using effective score system, thus reducing the risk of lifetime radiation induced fatal cancer. Patients and Methods: Clinical data from 61 patients admitted to surgery department in Abdulrahman Al-Mishari Hospital (Riyadh- Kingdoms Saudi Arabia) who had undergone an emergency appendectomy was retrospectively collected following 15 RIPAS score system. The probability was calculated and a score of 0.5, 1.0 or 2.0 was allocated to each parameter. The receiver operating curve (ROC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the new scoring system were derived using the stats direct statistical software. Results: The standard RIPAS score system for acute appendicitis had a sensitivity of 88% and a specificity of 67% with accuracy of 81%. In the modified RIPAS scoring system, CT finding were substituted for RIPAS scores in the ranges of 7 to 8, 7 to 9, 7 to 10, 7 to11 and 7 to 12. The modification resulted in the greatest accuracy 95% in diagnosis appendicitis in patients with score in the range of 7 to 12. This modification theoretically would have decreased the use of CT by about 30% in this group of retrospectively studied patients. Furthermore, in patients with RIPAS score of 2to 6, another diagnosis should be considered; in patients with score of 7 to 12, CT should be performed; and in patients with score 13 to 16, appendectomy should be performed promptly without further studies. Conclusion: The modified RIPAS score is useful as an aid in diagnosis acute appendicitis in the adult populations. This scoring system eliminates unnecessary use of CT and the attendant potential cancer-inducing radiation.
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Introduction: Decision making in cases of acute appendicitis may be difficult especially for junior surgeons. Appendicitis is an important differential diagnosis in patients with right iliac fossa pain. Radiological investigations do not appear to be always helpful. Many diagnostic scores have been advocated but most are complex and difficult to implement in a clinical situation. The Alvarado Score was described in 1986 and has been validated in adult surgical practice. Alvarado Score, is a simple scoring system that can be instituted easily. Free of cost and reduce the incidence of negative appendicectomies. Material and Methods: We studied the Alvarado score of 200 patients in 11 months period who presented to the emergency department with right iliac fossa pain and found that patients with a low Alvarado score (less than 5) did not have appendicitis. Thus, we decided to design this study with the aim of investigating whether the Alvarado Score can be used by emergency doctors as a criterion for diagnosing acute appendicitis. We compared the Alvarado Score with the operative findings and grade of appendicitis.Results: A total of hundred patients were studied. We found that patients who had a score of less than 5 had a normal appendix, but at the same time 17% had acute appendicitis, where Alvarado Score >5 59% had acute appendicitis and 1% have normal appendix. Thus the Alvarado Score is both specific and sensitive in diagnosis of acute appendicitis. Conclusion: It is concluded that Alvarado score is a free and easy to use tool and is very helpful in diagnosing acute appendicitis and decreasing the incidence of negative appendectomies.
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To determine the usefulness of RIPASA score for the diagnosis of acute appendicitis using histopathology as a gold standard. Cross-sectional study. Department of General Surgery, Combined Military Hospital, Kohat, from September 2011 to March 2012. A total of 267 patients were included in this study. RIPASA score was assessed. The diagnosis of appendicitis was made clinically aided by routine sonography of abdomen. After appendicectomies, resected appendices were sent for histopathological examination. The 15 parameters and the scores generated were age (less than 40 years = 1 point; greater than 40 years = 0.5 point), gender (male = 1 point; female = 0.5 point), Right Iliac Fossa (RIF) pain (0.5 point), migration of pain to RIF (0.5 point), nausea and vomiting (1 point), anorexia (1 point), duration of symptoms (less than 48 hours = 1 point; more than 48 hours = 0.5 point), RIF tenderness (1 point), guarding (2 points), rebound tenderness (1 point), Rovsing's sign (2 points), fever (1 point), raised white cell count (1 point), negative urinalysis (1 point) and foreign national registration identity card (1 point). The optimal cut-off threshold score from the ROC was 7.5. Sensitivity analysis was done. Out of 267 patients, 156 (58.4%) were male while remaining 111 patients (41.6%) were female with mean age of 23.5 ± 9.1 years. Sensitivity of RIPASA score was 96.7%, specificity 93.0%, diagnostic accuracy was 95.1%, positive predictive value was 94.8% and negative predictive value was 95.54%. RIPASA score at a cut-off total score of 7.5 was a useful tool to diagnose appendicitis, in equivocal cases of pain.
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Objective: Comparative study of Diagnostic accuracy of Modified Alvarado Score and Ultrasonography in Acute Appendicitis.Research design and methods: A total of 55 patients of age group between 7-65yrs,both male and females,with clinical features suggestive of acute appendicitis were selected non-randomly for the study.Data was collected as Alvarado score,ultrasonograpic findings and histopathological reports.Statistical analysis was performed and results of both Alvarado score and Ultrasonography were compared.Results: Of 55 patients taken,maximum percentage of patients were in age group 10-20yrs with males dominated the series.The sensitivity and specificity of Modified alvarado score was 82.05% and 81.25% with PPV 91.42% and NPV 65% and diagnostic accuracy of 81.82% respectively.Ultrasonography study revealed 84.61% sensitivity and specificity of 56%,PPV and NPV were 80.48% and 57.14% and diagnostic accuracy was 70.91% respectively.Conclusions: From present study,it is concluded that Modified Alvarado score is better diagnostic tool than ultrasonography alone in diagnosis of acute appendicitis. Acute appendicitis is one of the commonest surgical emergency. A case of appendicitis can progress to perforation and other life threatening complications, which is associated with much higher morbidity and mortality and the surgeons are left with no option than to operate, when diagnosed clinically rather than to wait until it is confirm. Despite the
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Objective: To compare the diagnostic accuracy of clinical examination with that of a diagnostic protocol consisting of ultrasound and Alvarado score in patients with acute appendicitis. Material and Methods: A study comparing clinical diagnosis (control group) with a diagnostic protocol incorporating Ultrasound and Alvarado score (intervention group) was conducted in surgical A ward Lady Reading Hospital from February 2004 to March 2006. Total of 308 patients with suspected acute appendicitis were considered for the study.158 patients were randomized to control group and 150 patients to intervention group. Alvarado scoring system assessed all of 150 patient of the intervention group and 130 of these patients underwent ultrasound. The main out come measured were, time to operation, hospital stay, any adverse out come, negative appendicectomy and delayed operation leading to perforation. Results: Sensitivity and specificity of ultrasound and Alvarado scoring system were 97.91% and 75%, respectively. Patient in intervention group who underwent therapeutic operation had a significantly shorter mean time to operation than the patients in the control group (6.9 Vs 10.1 hours). There were no difference between groups in mean duration of hospital stay (61.3 Vs 62.5 hours), proportion of patients undergoing non therapeutic operations (1.33% Vs 4.33%) or delayed treatment in association with perforation of the appendix (3.33% Vs 11.9%). Conclusion: Ultrasound and the Alvarado scoring system is a diagnostic tool that leads to an early diagnosis and rapid surgical treatment of acute appendicitis. However it does not prevent complications or reduce the length of hospital stay.
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Objective: To compare IPASA and Alvarado scoring systems in terms of diagnostic accuracy for acute appendicitis. Methodology: The study was carried out from August 2010 to January 2012 at Princess Haya Hospital, Aqaba, Jordan and included 600 patients of suspected acute appendicitis. RIPASA and Alvarado scores were performed for all patients above 14 years in whom decision to operate was made already by independent surgeons. Sensitivity, specificity, predictive values and accuracy were calculated. Data were analyzed using SPSS 16 and STATA 11. Results: Out of 600 patients, mean age 26.52 years. Negative appendicectomy rate was 17%. Sensitivity for RIPASA and Alvarado scores were 93.2 and 73.7, respectively (P<0.001). Predicted negative appendicectomy rates for RIPASA and Alvarado systems were 7.8% and 8%, respectively (P=0.88). Conclusion: Both RIPASA and Alvarado scoring systems could significantly lower negative appendicectomy rate. However, RIPASA could identify a significant proportion of patients who would be otherwise missed by Alvarado score.
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Objective: To assess the efficacy of abdominal ultrasound in diagnosing acute appendicitis. Design: Retrospective study. Setting: Salmaniya Medical Complex, Kingdom of Bahrain. Method: Data collected from files of 312 patients who had appendectomy between 1 January to 31 December 2009. Result: Three hundred twelve patients had appendectomy, 114 (36.5%) had ultrasound (US) examination and only 57 (50%) showed radiological findings positive for appendicitis. Thiry-seven (11.9%) patients had negative appendectomy. Twenty-three (11.6%) had negative appendectomy in clinical group, 3 (5.3%) patients were negative in positive ultrasound group and 11 (19.3%) patients in negative ultrasound group. Conclusion: Ultrasound is not a reliable test to diagnose appendicitis as it carries low sensitivity and specificity, although it showed good predictive positive value.
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Background Patients presenting with suspected appendicitis pose a diagnostic challenge. The appendicitis inflammatory response (AIR) score has outperformed the Alvarado score in two retrospective studies. The aim of this study was to evaluate the AIR Score and compare its performance in predicting risk of appendicitis to both the Alvarado score and the clinical impression of a senior surgeon. Methods All parameters included in the AIR and Alvarado scores as well as the initial clinical impression of a senior surgeon were prospectively recorded on patients referred to the surgical on call team with acute right iliac fossa pain over a 6-month period. Predictions were correlated with the final diagnosis of appendicitis. Results Appendicitis was the final diagnosis in 67 of 182 patients (37 %). The three methods of assessment stratified similar proportions (~40 %) of patients to a low probability of appendicitis (p = 0.233) with a false negative rate of
Article
BACKGROUND The aim of this study was to investigate the integration of ultrasound (US) findings with Alvarado score in diagnosing or excluding acute appendicitis. METHODS: Data were analyzed in 122 pediatric patients with suspected appendicitis who had undergone US. The US findings were classified into four groups, and the patients were classified into three groups according to Alvarado score. US results and Alvarado score were compared. RESULTS: Alvarado score was a good predictor of appendicitis for scores ≥7. CONCLUSION: In the case of non-visualization of the appendix without a high Alvarado score, appendicitis can be safely ruled out.