Diagnostic Accuracy of Alvarado and Ripasa Scoring Systems for Diagnosis of Acute Appendicitis Taking Histopathology as Gold Standard
Imran Aslam, Rashid Mehmood, Yaseen Rafi, Zain Mukhtar, Khalid Masood Gondal
797
ABSTRACT
Aim: To determine diagnostic accuracy of
Alvarado and RIPASA scoring systems for diagnosis of acute appendicitis taking
histopathology as gold standard.
Study Design: Cross Sectional study
Setting and Duration: Surgery Department (A&E), King Edward Medical University/ Mayo
Hospital Lahore, Pakistan from March 2016 to February 2017.
Methodology: Total 520 patients (aged 18-80 years) of either gender presenting with
right iliac fossa pain within 7 days, who were admitted from emergency surgery department
of Mayo Hospital Lahore were included. Demographic information like name, age,
sex, address were obtained. RIPASA score and Alvarado score calculated as
described in annexure I and II. After appendicectomies, resected specimen were
sent for histopathological examination by consultant pathologist at Pathology department
of Mayo hospital Lahore. All patients were diagnosed on Alvarado Score and RIPASA Score. Non Probability
consecutive Sampling technique was applied and the collected data was entered
and analyzed using SPSS version 20. Post stratification chi-square test
performed to see significance of effect modifiers. p-value ≤ 0.05 will be
considered as significant.
Results: The
mean age of patients was 37.27±13.83 years. There were 381(73.3%) male and
139(26.7%) female patients. The sensitivity, specificity, Positive predictive
value(PPV), Negative Predictive value (NPV) of RIPASA score was 99.4%, 95.72%,
97.64% and 98.9%. The sensitivity, specificity, PPV, NPV of Alvarado score was
98.5%, 96.79%, 98.2% and 97.31%. The diagnostic accuracy of RIPASA (98.08%) was
higher than the diagnostic accuracy of Alvarado score (97.88%).
Conclusion: The diagnostic accuracy of RIPASA score was found high
when compared to Alvarado score taking histopathology as gold standard. In
future we can confidently use RIPASA instead of Alvarado score to diagnose
acute appendicitis and decrease the rate of negative appendectomy and morbidity
caused due to missed diagnosis.
Key Words: Appendix,
Alvarado, RIPASA, Histopathology, negative
appendectomy
ABSTRACT
Aim: To determine diagnostic accuracy of
Alvarado and RIPASA scoring systems for diagnosis of acute appendicitis taking
histopathology as gold standard.
Study Design: Cross Sectional study
Setting and Duration: Surgery Department (A&E), King Edward Medical University/ Mayo
Hospital Lahore, Pakistan from March 2016 to February 2017.
Methodology: Total 520 patients (aged 18-80 years) of either gender presenting with
right iliac fossa pain within 7 days, who were admitted from emergency surgery department
of Mayo Hospital Lahore were included. Demographic information like name, age,
sex, address were obtained. RIPASA score and Alvarado score calculated as
described in annexure I and II. After appendicectomies, resected specimen were
sent for histopathological examination by consultant pathologist at Pathology department
of Mayo hospital Lahore. All patients were diagnosed on Alvarado Score and RIPASA Score. Non Probability
consecutive Sampling technique was applied and the collected data was entered
and analyzed using SPSS version 20. Post stratification chi-square test
performed to see significance of effect modifiers. p-value ≤ 0.05 will be
considered as significant.
Results: The
mean age of patients was 37.27±13.83 years. There were 381(73.3%) male and
139(26.7%) female patients. The sensitivity, specificity, Positive predictive
value(PPV), Negative Predictive value (NPV) of RIPASA score was 99.4%, 95.72%,
97.64% and 98.9%. The sensitivity, specificity, PPV, NPV of Alvarado score was
98.5%, 96.79%, 98.2% and 97.31%. The diagnostic accuracy of RIPASA (98.08%) was
higher than the diagnostic accuracy of Alvarado score (97.88%).
Conclusion: The diagnostic accuracy of RIPASA score was found high
when compared to Alvarado score taking histopathology as gold standard. In
future we can confidently use RIPASA instead of Alvarado score to diagnose
acute appendicitis and decrease the rate of negative appendectomy and morbidity
caused due to missed diagnosis.