Comparison of Alvarado and RIPASA scoring systems in diagnosis of acute appendicitis and correlation with intraoperative and histopathological findings

Abstract

Background: Despite extraordinary advances in modern radiology and laboratory investigations an accurate diagnosis of acute appendicitis cannot be made in atypical cases. No single diagnostic aid can dramatically reduce the rate of negative appendicectomy.Methods: To reduce the rate of negative appendicectomies, application of RIPASA and Alvarado scoring done in every clinically diagnosed cases of appendicitis in a prospective study from January 2015 to January 2016 was done. 100 patients with right lower quadrant abdominal pain fulfilling the inclusion and exclusion criterion underwent appendicectomy in Mahatma Gandhi Hospital, Dr. S.N. Medical college, Jodhpur, Rajasthan, India.Results: The results of both scoring system were reported and were correlated with intraoperative and histopathological findings. Chi-square test was applied to calculate the p-value for the association between the variables of studied. The mean age was 24.86 years (10-80 years) and there were 61 males and 39 females in the study. Histopathological examination confirmed appendicitis in 95 patients with 5 negative appendicectomies. Negative appendicectomy rate for RIPASA and Alvarado score was 2.17% and 1.54% respectively. Accuracy for RIPASA and Alvarado score was 93% and 68% respectively.Conclusions: RIPASA score is a more valuable tool for diagnosing acute appendicitis with 93% accuracy, sensitivity 94.74% and specificity 60%; inspite of sophisticated investigations like CT, thus reducing the cost of treatment and minimize negative appendicectomy rate.