Evaluating the Diagnostic Efficacy of RIPASA vs. Alvarado Scores in Acute Appendicitis: A Prospective Comparative Analysis

Article Information

Title: Evaluating the Diagnostic Efficacy of RIPASA vs. Alvarado Scores in Acute Appendicitis: A Prospective Comparative Analysis

Authors: Faisal Ali, Sabahat Majeed, Abdullah Umer, Seerat Ijaz, Muhammad Farzan Anwar, Ahmed Salman Majeed, Bilal Qammar

Journal: Indus Journal of Bioscience Research (IJBR)

HEC Recognition History

Category	From	To
Y	2024-10-01	2025-12-31

Publisher: Indus Education and Research Network

Country: Pakistan

Year: 2024

Volume: 2

Issue: 2

Language: English

DOI: 10.70749/ijbr.v2i02.151

Keywords: SensitivitySpecificityDiagnostic accuracyAcute appendicitisAlvarado scoreRIPASA scoreEmergency surgery

Abstract

Background: Appendicitis is the third most common cause of emergency abdominal surgery worldwide, but diagnosis remains challenging. Clinical scoring systems like Alvarado and RIPASA aim to improve diagnostic accuracy. While the Alvarado score is widely accepted, it is more commonly applied in Western populations. In contrast, the RIPASA score was developed for Southeast Asian populations, reflecting demographic variations in appendicitis presentation. This study compares the accuracy of the RIPASA and Alvarado scores against histopathological findings, the traditional gold standard.
Methods: A prospective, comparative study was conducted on 255 patients with suspected acute appendicitis. Upon admission, both RIPASA and Alvarado scores were calculated. Diagnostic performance was evaluated using sensitivity, specificity, PPV, NPV, and overall accuracy. Concordance between scoring systems was analyzed with Cohen’s Kappa, and McNemar’s test assessed statistical significance in performance differences.
Results: The RIPASA score demonstrated superior sensitivity at 92% compared to 85% for Alvarado, with both scoring 75% specificity. The PPV for RIPASA was 96%, marginally higher than Alvarado’s 95%, indicating high accuracy in detecting true positives. RIPASA’s NPV was 75%, yielding fewer false negatives than Alvarado. McNemar’s test showed a significant difference (p &lt; 0.05) favoring RIPASA, and Cohen’s Kappa indicated moderate to substantial agreement (0.6–0.8). Conclusion: RIPASA offers better diagnostic performance than Alvarado, particularly in multicultural settings, due to its higher sensitivity and comparable specificity. While both scores have moderate NPVs, additional diagnostic methods may be necessary for complex cases. Further studies are needed to validate these findings across diverse populations

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Research Objective

To compare the diagnostic accuracy of the RIPASA and Alvarado scoring systems against histopathological findings in patients with suspected acute appendicitis.

Methodology

A prospective, comparative observational study was conducted on 255 patients presenting with suspected acute appendicitis at Mayo Hospital, Lahore, from July 2024 to September 2024. Both RIPASA and Alvarado scores were calculated upon admission. Diagnostic performance was evaluated using sensitivity, specificity, PPV, NPV, and overall accuracy. Concordance was analyzed with Cohen's Kappa, and McNemar's test assessed statistical significance in performance differences. The study adhered to the STARD 2020 checklist.

Methodology Flowchart

                        graph TD
    A[Patient Admission with Suspected Acute Appendicitis] --> B[Calculate RIPASA Score];
    A --> C[Calculate Alvarado Score];
    B --> D[Data Documentation on Case Report Forms];
    C --> D;
    D --> E[Histopathological Assessment Gold Standard];
    D --> F[Statistical Analysis Sensitivity, Specificity, PPV, NPV, Accuracy, Kappa, McNemar's Test];
    F --> G[Compare Diagnostic Efficacy];
    G --> H[Conclusion on RIPASA vs. Alvarado Performance];

Discussion

The RIPASA score exhibits superior sensitivity in identifying true positive cases of acute appendicitis across diverse populations, potentially reducing unnecessary appendectomies. While both scores have high PPVs, their NPVs are moderate, suggesting the need for additional diagnostic methods in complex or borderline cases. The study aligns with previous research highlighting RIPASA's efficacy, particularly in Asian populations, due to its inclusion of more parameters.

Key Findings

The RIPASA score demonstrated superior sensitivity (92%) compared to the Alvarado score (85%), with both achieving 75% specificity. RIPASA had a marginally higher PPV (96% vs. 95%) and a better NPV (75% vs. ~70%). McNemar's test showed a statistically significant difference (p < 0.05) favoring RIPASA, and Cohen's Kappa indicated moderate to substantial agreement (0.6-0.8) between the two systems.

Conclusion

The RIPASA score offers better diagnostic performance than the Alvarado score, with higher sensitivity and comparable specificity, making it a more reliable tool for diagnosing acute appendicitis, especially in multicultural settings. Both scores are valuable in clinical decision-making, but RIPASA's enhanced accuracy can lead to improved patient management and outcomes.

Fact Check

1. Sample Size: The study enrolled 255 patients.
2. RIPASA Sensitivity: The RIPASA score demonstrated a sensitivity of 92%.
3. Alvarado Specificity: The Alvarado score achieved a specificity of 75%.

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