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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. Luke’s Hospital, Kilkenny, Ireland
2
Department of Surgery, University Hospital Waterford,
Waterford, Ireland
Int J Colorectal Dis (2017) 32:491–497
DOI 10.1007/s00384-016-2713-4
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