A Comparison between Alvarado and RIPASA Scoring Systems in Diagnosis of Acute Appendicitis

Background: Acute appendicitis presents surgeons with a diagnostic dilemma due to a large range of differential diagnoses and, in certain cases, unusual presentation. The most prevalent modality of diagnosis, sonography, has a very low specificity and sensitivity. It puts a surgeon in a difficult situation, especially in an emergency. In acute appendicitis, incorporating clinical scoring into the diagnostic process has been proven to improve decision-making and lower the rate of negative appendectomy.

Methods: This prospective observational study aimed to assess the efficacy of the Alvarado and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) ratings in the pre-operative diagnosis of acute appendicitis, as well as the correlation between these scores and histopathological diagnosis.

For the study, 100 cases that met the inclusion and exclusion criteria were selected. A diagnosis of acute appendicitis was made based on a complete history and a thorough clinical examination. The RIPASA score was found to have a greater sensitivity for detecting acute appendicitis. The RIPASA and Alvarado scoring systems had a negative appendectomy rate of 11.5 and 19.2 percent, respectively, whereas sonography had a rate of 12 percent.

Conclusions: Clinical scoring is a fast, easy, reliable, non-invasive, repeatable, and safe diagnostic technique for acute appendicitis without additional cost or risks. This study found that RIPASA is a better grading system for acute appendicitis diagnosis than Alvarado.