Alvardo vefrsus modifies ripasa score in diagnosis of acute appendicitis
1Rimsha Malik, 2Dr Fazli Junaid, 3Dr Javaria manzoor, 4Mansoor Ali, 5Taimoor Ghori, 6Khurram Ali
1Mohtarma benazir Bhutto shaheed medical college mirpur AJK
2Assistant Professor, General surgery Ayub Teaching Hospital Abbottabad KPK
3Azad Jammu and Kashmir medical college muzaffarbad
4UHS Lahore
5PIMS Islamabad
6PIMS Islamabad
Vol: 14/02
Received: January 12, 2025 Accepted: March 11, 2025 Published: July 26, 2025
Abstract
Background: Appendicitis as a peritonitis is one of the most common surgical conditions which if not diagnosed early, it could lead to perforation and peritonitis. Clinical assessment, biochemical and haematological examinations and neuroradiological investigations as single approaches present low sensitivity and specificity. These two clinical scoring systems include the Alvarado and the Modified RIPASA which were developed with improved diagnostic accuracy of acute appendicitis. Of those, the Modified RIPASA score was designed to solve the deficiencies of the Alvarado score in various populations.
Aim: The objective of this study will be to establish whether the use of Alvarado score or the modified RIPASA score yield the highest diagnostic accuracy for the diagnosis of acute appendicitis in practice.
Method: A cross-sectional prospective consecutive case series involving 300 patients with RLOP suspected to have acute appendicitis was done. They were also assessed using Alvarado and Modified RIPASA score system. Information was obtained by means of clinical evaluation, biochemical measurements, and radiology. The performances of each scoring systems were determined by calculating the sensitivity and specificity and the positive and negative predictive values and overall accuracy. Additional to compare the Area Under the Curve (AUC) of each score, the Receiver Operating Characteristic (ROC) curves were also constructed.
Results: Diagnostic efficacy of the Modified RIPASA score was found to be high with sensitivity of 90 %, specificity of 78 %, PPV of 88 % and NPV of 81 %. Specifically, for the Alvarado score herein, a sensitivity of 80%, specificity of 70%, an accuracy of 76%, PPV of 84%, an NPV of 64% and an LR+ of 3
and an LR- of 0.26 were revealed. The overall performance of the new proposed score named Modified RIPASA was 85% while the performance of the often used Alvarado score was 75%. The ROC curve analysis also substantiated this observation and significantly favouring the Modified RIPASA score which had an AUC of 0. 85 versus 0. 75 for the Alvarado score of my patient. Conclusion: The authors have noted that the modified RIPASA score is superior and more sensitive than the Alvarado score as a diagnostic test in acute appendicitis especially in diverse population. The higher sensitivity and specificity makes it particular useful in clinical decisions, which may help decrease the proportion of people having to undergo an operation unnecessarily or those in whom the condition is not detected before the operation, thereby enhancing the patients’ well-being. Keywords: Acute appendicitis, Alvarado score, Modified RIPASA score, diagnostic accuracy, clinical scoring systems, sensitivity, specificity.
