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Clinical study of ALVARADO verses RIPASA score in diagnosing acute appendicitis

Author: 
Syed Mushtaq Ahmad Shah, Ishfaq Ahmad Gilkar, Hanief Mohamed Dar and Varun Dogra
Subject Area: 
Health Sciences
Abstract: 

Introduction: Acute Appendicitis is one of the most common surgical emergency encountered in hospitals making up 10% of all emergency abdominal surgeries. Early diagnosis and timely intervention is essential in preventing complications associated with Acute Appendicitis. Methods: 100 patients of Acute Appendicitis were included in our study. A complete pre-operative workup was done in all patients. ALVARADO and RIPASA scoring was calculated and compared in terms of Intraoperative findings ,Sensitivity, specificity, Positive predictive value (PPV), Negative predictive value(NPV), diagnostic accuracy and negative appendectomy rates with respect to histopathology, as gold standard for diagnostic confirmation. Results: 88 patients were having ALVARADO score>7 and 96 patients with RIPASA score >7.5, While as 12 patients had Alvarado score< 7 and 4 patients with RIPASA SCORE <7.5. Out of the100 patients operated, 93 patients were reported as having AA whereas 7 patients were reported as having normal Appendix. Among 88 patients who were having ALVARADO score of >7, 86 were having Appendicitis on Histopathological report and the remaining 2 were reported having normal APPENDIX. 12 patients who were having ALVARADO score <7, 7 were having. Appendicitis and 5 were having no appendicitis. out of 96 patients who were having RIPASA score>7.5, 92 were having Appendicitis where as other 4 patients didn’t have AA. Patients with RIPASA score of<7, 1 patient had AA whereas 3 patients had no appendicitis on histipathological examination. On comparing both the scoring system in all the100patients, we found that sensitivity of RIPASA scoring is greater than ALVARADO scoring system 98.92 and 92.47 respectively, specificity of RIPASA scoring system is less than ALVARADO scoring system 42.85and71.42respectively.Positive predictive value of RIPASA scoring system is less than ALVARADO scoring system 95.83and 97.72 respectively. Negative predictive value of RIPASA scoring system greater than ALVARADO scoring system 75 and 41.66 respectively. Accuracy of RIPASA scoring system is greater than ALVARADO scoring system 95 and 91 respectively. Conclusion: RIPASA scoring system is more sensitive(98.92%) as compared to Alvarado scoring system (92.47%). However Alvarado scoring system is more specific (71.72%) as compared to RIPASA scoring system (42.85%)

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