Evaluation of Alvarado score and RIPASA score for diagnosis of appendicitis
Abstract
Background : Acute appendicitis is the most common surgical abdominal emergency. An early diagnosis and prompt operation can reduce an unacceptable complication. This present study aims to evaluate the usefulness of Alvarado score and RIPASA score for diagnosis of appendicitis.
Methods : This is a retrospective descriptive study. Charts were reviewed of all patients who underwent appendectomy for presumed acute appendicitis over a 13 month period at Sirindhorn Hospital, Khon Kaen province between October 2016 and July 2018. Alvarado score with 7 as the optimal cutoff value. RIPASA score with 7.5 as the optimal cutoff value. Diagnosis was confirmed by histopathological examination. Sensitivity, Specificity, PPV, NPV, FP, FN, LRs, and Accuracy were calculated.
Results : Of 145 patients undergoing appendectomy (mean age 35.86 ± 20.45[SD] years), with a female to male ratio 1.27:1. Alvarado score with 7 as the optimal cutoff value: Sensitivity, Specificity were 90.1%,
28.6%. PPV, NPV, FP, FN were 92.19%, 23.53%, 71.4 %, 9.9%. (LR+) 1.26, (LR-) 0.35, Accuracy was 84.14%, Negative appendectomy rate was 7.8%, Perforation rate was 19.5%, the AUC was 0.585 (95% CI = 0.407-
0.762). RIPASA score with 7.5 as the optimal cutoff value: Sensitivity, Specificity were 100%, 0%. PPV 90.34, FP and FN were 100 % and 0 %. (LR+) 1.0, Accuracy was 84.14%, Negative appendectomy rate was 9.7%, Perforation rate was 18.6%, the AUC was 0.691 (95% CI = 0.556-0.825). For NPV and (LR-), we can’t evaluate due to none of patients has RIPASA score < 7.5. This study, we found the better optimal cut-off threshold score from ROC for RIPASA score is at 10.75. At this new value, will give sensitivity 93.1 %, specificity 28.6 %. PPV, NPV, FP, FN were 92.42%, 69.23%, 71.4%, 6.9%. (LR+) 1.30, (LR-) 0.24, Accuracy
86.89% and Negative appendectomy rate 7.6%, Perforation rate 20.5%
Conclusion : RIPASA score with 7.5 as the optimal cutoff value has more sensitivity and accuracy than Alvarado score, but could not rule in patients for appendicitis. We found a new optimal cutoff value for RIPASA score, at 10.75 could rule out and rule in patients for appendicitis equally as Alvarado score. Nevertheless, RIPASA score with 10.75 as cutoff value could be safely used by general practitioners in deciding whether to refer a patient to hospital and could be as a decision rule for admission/ observation as Alvarado score.
Keywords : Appendicitis, Alvarado score, RIPASA score, diagnosis
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