A comparative study of RIPASA and Alvarado score for the diagnosis of acute appendicitis

Praveena Suresh, Rajan Janardhanan, Deepak Paul


Background: Acute appendicitis is a common problem and can be difficult to diagnose at time. There are many scoring systems to predict the diagnosis of acute appendicitis. The most commonly used scoring system is Alvarado scoring system but, it is far from perfect. In this study we compare Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system to Alvarado scoring system in correctly diagnosing acute appendicitis.

Methods: This prospective observational study was conducted in the department of general surgery, Sree Gokulam Medical College and Research Foundation. It comprised of 60 consecutive patients who were admitted with suspicion of appendicitis who had right iliac fossa pain. RIPASA and Alvarado scoring was done and compared to histopathology after surgery. Sensitivity, specificity and accuracy was calculated.

Results: Majority of the patients were below 30 years of age majority were males 36 (60%). When Alvarado score predicted appendicitis in 31 (51.77%) and RIPASA in 54 (90%). When the RIPASA score was >7.5 the sensitivity was 100%, specificity 67% and accuracy was 95%.

Conclusions: RIPASA scoring system is more accurate to diagnose acute appendicitis especially when RIPASA score is >7.5. literatures.


RIPASA score, RIPASA versus Alvarado score, Negative appendicectomy

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Stephens PL, Mazzucco JJ. Comparison of ultrasound and the Alvarado score for the diagnosis of acute appendicitis. Conn Med. 1999;63(3):137-40.

Cuschieri A. The small intestine and vermiform appendix. Essent Surg Pract. 3rd edition. London Butter worth Heinman. 1995;1325-8.

Velanovich V, Satava R. Balancing the normal appendectomy rate with the perforated appendicitis rate: implications for quality assurance. Am Surg. 1992;58(4):264-9.

Kalan M, Talbot D, Cunliffe WJ, Rich AJ. Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Surg Engl. 1994;76(6):418.

Chong CF, Adi MIW, Thien A, Suyoi A, Mackie AJ, Tin AS, et al. Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis. Singapore Med J. 2010;51(3):220.

Wani MM, Yousaf MN, Khan MA, BabaAbdul A, Durrani M, Wani MM, et al. Usefulness of the Alvarado scoring system with respect to age, sex and time of presentation, with regression analysis of individual parameters. Internet J Surg. 2007;11(2):1-5.

Humes DJ, Simpson J. Acute appendicitis. BMJ. 2006;333(7567):530-4.

Kumar A, Ramakrishnan TS, Sahu S. Differential Diagnosis for Acute Appendicitis: Epiploic Appendagitis. Med journal, Armed Forces India. 2009;65(3):276-7.

John H, Neff U, Kelemen M. Appendicitis diagnosis today: clinical and ultrasonic deductions. World J Surg. 1993;17(2):243-9.

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15(5):557-64.

N N, Mohammed A, Shanbhag V, Ashfaque K, S A P. A Comparative Study of RIPASA Score and ALVARADO Score in the Diagnosis of Acute Appendicitis. J Clin Diagn Res. 2014;8(11):NC03-5.

Chong CF, Thien A, Mackie AJA, Tin AS, Tripathi S, Ahmad MA, et al. Comparison of RIPASA and Alvarado scores for the diagnosis of acute appendicitis. Singapore Med J. 2011;52(5):340-5.

Alnjadat I, Abdallah B. Alvarado versus RIPASA score in diagnosing acute appendicitis. Rawal Med J. 2013;38(2):147-51.

Akbar I, Shehzad JA, Ali S. Diagnostic Accuracy Of Ripasa Score. J Ayub Med Coll Abbottabad. 2019;31(3):411-4.