RIPASA Scores; a Reliable Score for Diagnosis of Acute Appendicitis

Abstract

OBJECTIVE: To establish the diagnostic precision of the RIPASA score for Acute Appendicitis taking histopathology as a gold standard. METHODOLOGY: Cross-Sectional Study using non-probability consecutive sampling including 484 patients of both gender with migratory abdominal pain to right iliac fossa 10000mm3 .This study was carried out at General Surgery Department, Jinnah Postgraduate Medical Centre Karachi, from May 2017 to February 2018.Patients with ASA scores III-VI, gangrenous appendicitis, peritonitis, and pregnant women were excluded. RIPASA score was assessed on admission, score summated, and had no effects on management. A score> 7.5 was considered positive for acute appendicitis. The diagnosis was made clinically and with the help of abdominal sonography. Postoperatively specimens were sent for histopathology; results were noted, and diagnostic accuracy was recorded. SPSS version 22 was used to analyze the data. RESULTS: The age range was 20 to 50 years with a mean of 33.892±7.36 years, mean duration of complaint was 3.161±1.16 days, and mean weight was 79.402±8.42 Kg. The majority of patients were males (68.4%). Ripasa score > 7.5 diagnosed 78(16.1%) and 83(17.1%) confirmed by histopathology. Ripasa score > 7.5 had 83.1% sensitivity, 97.8% specificity and diagnostic accuracy 95%, PPV 88.46%, NPV 96.55%, Likelihood positive and negative ratio 37.04 and 0.172 respectively. Ripasa score of 6.5 had a sensitivity of 85.5% and specificity of 94.3%, as shown by the ROC curve and its coordinates. CONCLUSION: RIPASA is a manageable and comprehensive scoring system with high sensitivity and specificity for diagnosing acute appendicitis.

Keywords

• acute appendicitis
• ripasa
• diagnostic accuracy
• right iliac fossa’s pain
• roc (receiver operating characteristic)