# An evaluation of the comparative effectiveness of the RIPASA and Alvarado scoring systems in diagnosing acute appendicitis: a cross-sectional study

## TL;DR

This study compares two scoring systems for diagnosing appendicitis and finds that RIPASA outperforms Alvarado in accuracy and reducing unnecessary surgeries.

## Contribution

The study provides a direct comparison of RIPASA and Alvarado scores in a Pakistani population, highlighting RIPASA's superior diagnostic performance.

## Key findings

- RIPASA showed higher sensitivity (94.2%) and specificity (94.8%) compared to Alvarado (34.4% and 75.8%).
- RIPASA had a 94% diagnostic accuracy versus 51% for Alvarado in diagnosing acute appendicitis.
- RIPASA resulted in fewer negative appendectomies compared to Alvarado.

## Abstract

The aim of this research is to evaluate the diagnostic precision of the Alvarado and RIPASA scoring systems in detecting acute appendicitis. This will be done by comparing their outcomes with histopathology, which is considered the most reliable benchmark for comparison. Accurate and prompt identification of acute appendicitis is crucial in order to avoid complications such as perforation and peritonitis. Over the years, several clinical scoring systems have been developed to aid in the diagnosis of acute appendicitis. The RIPASA (Raja Isteri Pengiran Anak Saleha Appendicitis) and Alvarado scoring systems are well recognised in the medical field. It is essential to do a comparison examination of these two scoring systems because to the possible changes in sensitivity, specificity, and overall diagnostic accuracy.This study included 145 male and female patients who presented with right iliac fossa discomfort and were thought to have acute appendicitis. Two diagnostic grading systems were used to guide surgical choices. Alvarado Score: Patients having a score of 7 or above were subjected to an appendectomy. RIPASA Score: Patients with a score less than 12 also had an appendectomy. 145 individuals included between the ages of 13 and 60, the Alvarado score was found to have a sensitivity of 34.4%, specificity of 75.8%, diagnostic accuracy of 51%, positive predictive value of 68.2%, and negative predictive value of 43.5% for diagnosing acute appendicitis. On the other hand, the RIPASA score performed better, with a sensitivity of 94.2%, specificity of 94.8%, diagnostic accuracy of 94%, positive predictive value of 96.5%, and negative predictive value of 91.6%. In the adult Pakistani population, the RIPASA scoring system demonstrates superior accuracy, sensitivity, specificity, PPV, and NPV compared to the Alvarado score, with a lower rate of negative appendectomies.