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Background: The diagnosis of acute appendicitis usually follows a direct approach. Despite the development of many appendicitis scores, the negative appendectomy is still problematic. Objectives: The aim of this study was to compare RIPASA score versus pediatric appendicitis score (PAS) for the diagnosis of acute appendicitis in children. Methods: One hundred and fifty-four pediatric patients aged from 1 to 14 years old were enrolled in this study. All of which presented to the emergency Department with symptoms suggestive of acute appendicitis. The patients were analyzed using the RIPASA and PAS on admission. The cut off threshold score proposed for RIPASA score and PAS were 7.5 and 6 respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were reported and compared based on correlation between the preoperative score and histopathological assessment. Results: The cut-off threshold score proposed for RIPASA score and PAS was 7.5 and 6 respectively. At this cut off score, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of RIPASA score were 97.1%, 75%, 97%, 75% and 94.8% respectively. While those of PAS were 95.9%, 80%, 95%, 83% and 92.1% respectively. Conclusion: RIPASA score and PAS) were reliable and feasible clinical scoring systems for diagnosis of acute appendicitis in children. [ABSTRACT FROM AUTHOR]

Abstract Background Acute appendicitis is the most common surgical emergency in Ethiopian clinical practice. Although a multitude of scoring systems have been used in clinical practice, none have been universally validated. The purpose of this study was to validate the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system in the Ethiopian context. Methods A total of 315 consecutive patients who presented with a presumptive diagnosis of acute appendicitis and were planned to undergo appendectomy were studied. All the studied patients had diagnostic sonography and underwent the RIPASA scoring system. The sensitivity, specificity, positive predictive value, and negative predictive value of RIPASA and ultrasound results with intraoperative gross examinations. Results The mean age of the participants was 27.4 ± 11.5 years, with a male-to-female ratio of 1.6:1. The concordance between ultrasound and RIPASA for the diagnosis of acute appendicitis was 93.6%. The sensitivity, specificity, positive predictive value, and negative predictive value of RIPASA were 96.2%, 30.8%, 93.9%, and 42.1%, respectively. Similarly, the sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound were 95.3%, 27.8%, 95.6%, and 26.3%, respectively. White cell count and RIPASA scores were weakly correlated with intraoperative stages of acute appendicitis, r(313) = 0.18, p = 0.001, and r(313) = 0.129, p = 0.022, respectively. The rate of a negative appendectomy was 6%. Conclusion RIPASA and ultrasound had equivalent performance in the diagnosis of acute appendicitis. In both cases, the rate of negative appendectomy was low enough to validate RIPASA for clinical practice in low-income institutions where sonographic diagnosis by a conventionally trained radiologist is not available.

Background: Acute appendicitis is the most common surgical emergency in Ethiopian clinical practice. Although a multitude of scoring systems have been used in clinical practice, none have been universally validated. The purpose of this study was to validate the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system in the Ethiopian context. Methods: A total of 315 consecutive patients who presented with a presumptive diagnosis of acute appendicitis and were planned to undergo appendectomy were studied. All the studied patients had diagnostic sonography and underwent the RIPASA scoring system. The sensitivity, specificity, positive predictive value, and negative predictive value of RIPASA and ultrasound results with intraoperative gross examinations. Results: The mean age of the participants was 27.4 ± 11.5 years, with a male-to-female ratio of 1.6:1. The concordance between ultrasound and RIPASA for the diagnosis of acute appendicitis was 93.6%. The sensitivity, specificity, positive predictive value, and negative predictive value of RIPASA were 96.2%, 30.8%, 93.9%, and 42.1%, respectively. Similarly, the sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound were 95.3%, 27.8%, 95.6%, and 26.3%, respectively. White cell count and RIPASA scores were weakly correlated with intraoperative stages of acute appendicitis, r(313) = 0.18, p = 0.001, and r(313) = 0.129, p = 0.022, respectively. The rate of a negative appendectomy was 6%. Conclusion: RIPASA and ultrasound had equivalent performance in the diagnosis of acute appendicitis. In both cases, the rate of negative appendectomy was low enough to validate RIPASA for clinical practice in low-income institutions where sonographic diagnosis by a conventionally trained radiologist is not available. [ABSTRACT FROM AUTHOR]

Introduction: Acute appendicitis (AA) requires a prompt diagnosis. According to postoperative pathological results, a significant number of appendectomies are performed on a normal appendix (NA). The aim of this study is to evaluate the role of preoperative inflammatory markers in supporting and improving the clinical diagnosis of AA, extracting more information from CBC parameters. Methods: The study is a retrospective one. The histopathological results of operated appendix from 102 patients, who underwent appendectomy for clinically suspected AA, were extracted from the Galilee Medical Center systems. Two patient groups (NA and true AA) were compared for neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR) and mean platelet volume (MPV). The obtained data were statistically analyzed, using the independent sample t test and Mann–Whitney test. Category data have been compared among groups with the chi‐squared test. The primary endpoint of our research was to assess the predictive power of blood biomarkers. Results: Patients with suspected AA, based on clinical picture and contrast enhanced computed tomography (CECT), and with MLR‐value ≥0.3357 were 5.25 times more likely than normal to have AA. Patients with NLR‐value ≥3.2223 were 7 times more likely than normal to have AA. The differences in PLR and MPV values were not statistically significant. Conclusions: The NLR and MLR biomarkers can assist in diagnosis of AA. This can be particularly helpful in cases where CECT is contraindicated, as in pregnant women or children. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis a surgical emergencies is still a difficult diagnosis to make, especially in young persons, the elderly, and in reproductive-age women. Different scoring systems have been created to increase diagnostic accuracy based on clinical history and intial lab parameters. Objectives: This study was done to prospectively evaluate the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score for the diagnosis of acute appendicitis in patients presenting to the Accident and Emergency department or the Surgical wards with right iliac fossa pain. Methods: A prospective study was conducted in MVJ MC & RH on symptomatic patients presented with complaints of right iliac fossa pain. Clinical history and examination, radiological record and histopathologic reports were noted. We studied accuracy modified RIPASA score with Ultrasound and Histopathological reports in evaluation the diagnosis of acute appendicitis. Results: In our study we noted Sensitivity, specificity and diagnostic accuracy of modified RIPASA score was 89.5%, 66.7% and 88.3% respectively. Sensitivity, specificity and diagnostic accuracy of USG was 70.2%, 67% and 70%respectively. On combining modified RIPASA score with USG, Sensitivity, specificity and diagnostic accuracy were 98.2%, 66.7% and 96.7% respectively. Conclusion: On adding USG with modified RIPASA score there is increase in sensitivity and diagnostic accuracy. So modified RIPASA score with USG can be used in patient with RIF pain for making diagnosis of acute appendicitis.

Introduction: Acute appendicitis is one of the most common surgical emergencies. The ALVARADO score was developed to aid in the diagnosis of acute appendicitis. However, this score has poor sensitivity and specificity when applied to Asian populations. RIPASA score was then developed to help to diagnose acute appendicitis in Asian populations. The aim of this study was to compare between ALVARADO score and RIPASA score in the diagnosis of acute appendicitis in the local population. Methodology: Clinical data were obtained retrospectively from 188 files of patients who were diagnosed with acute appendicitis and undergone appendicectomy at Hospital Universiti Sains Malaysia from 2016 to 2017. All clinical data pertaining to the ALVARADO score and RIPASA score parameters were obtained from the files and written in performa. All patients diagnosed with acute appendicitis and who had undergone appendicectomy were included in the study except patients with pregnancy, age less than 5 years old and operation for other indications. Both data were analysed using SPSS version 24 and the sensitivity and specificity of each scoring system were compared. Results: A total of 188 patients were included in the study with mean age of 27.62 + 12.722 years old and mostly female. Negative appendicectomy for the patient in this study was 13.8%. RIPASA score with a cut of point 7.5 is more sensitive at 84.6% compared to the ALVARADO score with a score >7 78.4% and the specificity of the RIPASA score 57.7% is more than the ALVARADO score of 42.3%. Conclusion: RIPASA score is a better scoring system compared to the ALVARADO score in the diagnosis of acute appendicitis. [ABSTRACT FROM AUTHOR]

INTRODUCTION: RIPASA scoring system is the more suitable appendicitis scoring system developed for local settings that is south-east Asia and has high sensitivity, specificity and diagnostic accuracy. AIMS & OBJECTIVE: To evaluate the sensitivity, specificity, PPV, NPV of RIPASA score in diagnosing acute appendicitis. and to compare the diagnostic validity of RIPASA score with that of Alvarado score. MATERIAL & METHOD: All 100 cases were admitted under Department of General Surgery, Index Medical College Hospital & Research Centre, Indore, Madhya Pradesh, Study was non randomized observational of 18 months duration RESULTS: The RIPASA scoring system at the threshold value of 7.5 appears to be a better diagnostic scoring system than Alvarado scoring system in our local population. CONCLUSION: By comparision, RIPASA score is a better diagnostic scoring system when compared to Alvarado score in our local population. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is regarded as one of the most common inflammation that needs surgical intervention. Different scoring systems have been used for diagnosing of acute appendicitis. ALVARADO score is one of the most widely used score in diagnosing of acute appendicitis, but the accuracy of the latter is insufficiently low in Middle-East patients. Thus a new scoring system called RIPASA score has been designed for diagnosing of acute appendicitis in those patients. The aim of this study is to use RIPASA score and compare its result with ALVARADO score in diagnosing of acute appendicitis. Subjects and Methods: The study includes 200 patients with symptoms and signs of acute appendicitis in Al-Kindy Teaching Hospital/Baghdad/Iraq from 1st of November 2017 to 30th of November 2018. The variables of both scoring systems are registered for each patient included in this study and all patients who are underwent appendectomy their specimens are sent for histopathology. Results: The study includes 200 patients with suspicion of acute appendicitis. By applying both scores for each patient, then comparing the result of the two scores with the histopathology reports; RIPASA score has shown sensitivity, specificity, and diagnostic accuracy (93.6%, 74.4%, 89.5%) more than ALVARADO score (82.8%, 65.1%, 79%) respectively. The area under the receiver operating characteristic (ROC) curve of RIPASA score (0.957) is higher and significantly better than that of ALVARADO score (0.893) with P value

INTRODUCTION: Acute appendicitis is the most common condition encountered in general surgical practice. Alvarado scoring is the commonly used scoring systems for its diagnosis, but its performance has been found to be poor in Asian Population. Hence, we compared the RIPASA scoring system with Alvarado scoring system, to find out which is a better diagnostic tool for acute appendicitis in the Asian population. METHODS: We enrolled 48 patients who presented with RIF pain in the study. Both RIPASA and Alvarado scoring systems were applied to them, but management was carried out as per RIPASA score. Final diagnosis was confirmed either by post-operative HPE report. Final diagnosis was analysed against both RIPASA and Alvarado scoring systems. Sensitivity, Specificity, Positive PredictiveValue, Negative Predictive Value and Diagnostic Accuracy was calculated for both RIPASA and Alvarado scoring systems. RESULTS: It was found that RIPASA was better than Alvarado scoring system in terms of Specificity (67% v/s 50%) and Positive Predictive Value (95% v/s 93%), and also to some extent in terms of Diagnostic Accuracy (96% v/s 93%). Whereas the Sensitivity (100% in both) and Negative Predictive Value (100%) were similar in both. CONCLUSION: RIPASA is a more specific and accurate scoring system in our asian population, when compared to Alvarado scoring system. It reduces the number of missed appendicitis cases. [ABSTRACT FROM AUTHOR]

Background: The accuracy of different scores of acute appendicitis (AA) is extremely variable and sometimes unsatisfactory in different ethnic communities. The validity of the RIPSA score among the Eastern Mediterranean population is still questionable. Objective: This study aims at evaluating The RIPASA diagnostic accuracy for AA among Egyptians. Patients and Methods: The current prospective study included 123 patients suffering from AA attending the Emergency Surgery Department. All items of the RIPASA score were fulfilled. The diagnostic cut-off score for AA by RIPASA was 7.5. Histopathological assessment for the appendix was done for all included patients and correlated to the RIPASA score. Results: The mean age of the included patients was 31.85 (SD 8.7) years, and 76 (61.8%) of patients were <39.9 years old, while 47 (38.2%) were >40 years old. RIPASA score sensitivity for AA was 96.4% while the specificity was 75%. The positive predictive value was 97.27 %, while the negative predictive value was 69.23 %. The diagnostic accuracy was 94.3 %. Conclusion: RIPASA is a reliable and feasible score for AA with high sensitivity, positive predictive value, and diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Abstract Background Diagnosis of acute appendicitis remains a problem in children with right lower quadrant pain. Challenging diagnosis and fears of missing an inflamed appendix may lead to a negative appendectomy. Many scoring systems have been developed to reduce ambiguities in the diagnosis of appendicitis. Alvarado is one of the most commonly used scoring methods in pediatric patients. The RIPASA score is considered to be a better diagnostic scoring method in adults compared to Alvarado. The present study aims to compare RIPASA and Alvarado scoring systems in determining the possibility of acute appendicitis in children with right lower quadrant pain. This study included 179 consecutive pediatric patients who were referred to pediatric surgery with suspicion of acute appendicitis. The cut-off value was >7.5 for the RIPASA score vs. ≥7 for the Alvarado score. The possibility of appendicitis was divided into three groups for the Alvarado score and four groups for the RIPASA score. Results In this study, 158 of 179 patients were operated on. In 140 of the operated patients, the diagnosis of appendicitis was confirmed by histopathology. The negative appendectomy rate was 11.4%. Specificity and negative predictive value of RIPASA score were higher than those of Alvarado (p0.05). Conclusion The RIPASA scoring system can be used as an alternative to the Alvarado scoring system in the management of patients with right lower quadrant pain in emergency services and pediatric outpatient clinics. With the use of the RIPASA score, more patients with a low likelihood of appendicitis can be detected and further contributed to the reduction of the negative appendectomy rate.

Objective: To determine the diagnostic accuracy of Alvarado score and the RIPASA score for acute appendicitis using histopathology as a gold standard. Study Design: Cross sectional validation study. Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Mar to Sep 2018. Methodology: A total number of 270 patients were included in the study presenting with pain right iliac fossa to the Accident and Emergency department. Surgeons and Seniors Residents in Surgery on call in the Accident and Emergency Department. Combined Military Hospital, Rawalpindi, scored the patients with suspicion of acute appendicitis with Alvarado Score and RIPASA score simultaneously. After appendectomy of these patients, the removed appendix was sent for histopathology to confirm whether it was normal or inflamed. A 2x2 table was used for calculating sensitivity, specificity and diagnostic accuracy of the RIPASA score and Alvarado Score. The two scoring systems were then compared for diagnostic accuracy. Results: In our study, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of RIPASA score and Alvarado score for diagnosing acute appendicitis were 92.1%, 62.1%, 95.2%, 48.6%, 88.9% and 72.6%, 68.9%, 95.1%, 23.2%, 72.2% respectively. Conclusion: The diagnostic accuracy of RIPASA score was more than that of Alvarado score in diagnosing acute appendicitis.

Background Diagnosing acute appendicitis remains a problem, especially in teenagers with right lower quadrant pain. Imaging studies aid in accurate diagnosis but have limitations such as cost and availability. The Modified Alvarado Scoring System (MASS) is simple and cost-effective with fewer parameters. The Raja Isteri Pengiran Anak Saleha Appendicitis scoring system (RIPASA), designed for Asian populations, includes more parameters. This study compares the effectiveness of RIPASA and Alvarado scores in diagnosing acute appendicitis in a specific clinical setting. Objectives To compare the scoring systems of RIPASA and Alvarado in the diagnosis of acute appendicitis at a tertiary care hospital. Methods Data has been collected from all patients who attended the NRI general hospital emergency department and outpatient wing with acute appendicitis, admitted as inpatients based on clinical history and relevant investigations. Patients satisfying inclusion and exclusion criteria were selected and the basic investigations were done. Summary statistics were done using mean, standard deviation and proportions. Inferential statistics were done by using an independent t-test, kappa statistic, sensitivity and specificity with a 95% confidence interval (CI). All the measurements are done using the statistical package for the social sciences (SPSS) software version 21.0 (IBM Corp., Armonk, NY, USA) and open epidemiological (OpenEpi) software 3.01. A probability (p) <0.05 is considered as statistically significant. Results A total of 110 patients were analyzed for this study with a majority (39%) of them in the 21-30 age group. In our study, females (53%) outnumbered males (47%). Ultrasound findings in our cohort were acute appendicitis (93%), chronic appendicitis (2%) and normal appendix (5%). However, histopathology reported acute appendicitis (75%), chronic appendicitis (9%) and negative/non-specific (15%). The probability of appendicitis as predicted by Alvarado and RIPASA were 40% and 51% respectively. Definitive diagnosis of appendicitis was made in 16.4% with RIPASA whereas only 5.5% with Alvarado. When comparing the Alvarado and RIPASA scores, the sensitivity or true positive rate was higher for RIPASA (73.63%) than for Alvarado (50.55%). Conclusion There was a significant difference between the mean scores in Alvarado and RIPASA inpatients with scores suggestive of appendicitis and no appendicitis. Diagnostic accuracy was higher in RIPASA scoring compared to ALVARDO scoring. There was a significant statistical difference between the two scoring systems. When it comes to diagnosing in low-resource countries the study recommends a combination of Alvarado and RIPASA scoring systems., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. NRI Medical College & General Hospital issued approval IEC NRIMC 257. The IEC meeting has approved a comparative study of the RIPASA score and ALVARADO score in the diagnosis of acute appendicitis for 18 months. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Inteti et al.)

Background: Diagnosis of acute appendicitis remains a problem in children with right lower quadrant pain. Challenging diagnosis and fears of missing an inflamed appendix may lead to a negative appendectomy. Many scoring systems have been developed to reduce ambiguities in the diagnosis of appendicitis. Alvarado is one of the most commonly used scoring methods in pediatric patients. The RIPASA score is considered to be a better diagnostic scoring method in adults compared to Alvarado. The present study aims to compare RIPASA and Alvarado scoring systems in determining the possibility of acute appendicitis in children with right lower quadrant pain. This study included 179 consecutive pediatric patients who were referred to pediatric surgery with suspicion of acute appendicitis. The cut-off value was >7.5 for the RIPASA score vs. ≥7 for the Alvarado score. The possibility of appendicitis was divided into three groups for the Alvarado score and four groups for the RIPASA score. Results: In this study, 158 of 179 patients were operated on. In 140 of the operated patients, the diagnosis of appendicitis was confirmed by histopathology. The negative appendectomy rate was 11.4%. Specificity and negative predictive value of RIPASA score were higher than those of Alvarado (p<0.001). No difference was found between the two scores concerning sensitivity, positive predictive value, and the area under the receiver operator characteristics curve (p>0.05). Conclusion: The RIPASA scoring system can be used as an alternative to the Alvarado scoring system in the management of patients with right lower quadrant pain in emergency services and pediatric outpatient clinics. With the use of the RIPASA score, more patients with a low likelihood of appendicitis can be detected and further contributed to the reduction of the negative appendectomy rate. [ABSTRACT FROM AUTHOR]

Background Acute appendicitis is the most common surgical condition presented in emergency departments worldwide. It is also the most common cause of abdominal pain requiring surgery, with a lifetime risk of 7%. Objectives The aim of this study was to compare between the diagnostic accuracy of RIPASA score and Alvarado score in the diagnosis of acute appendicitis. Patients and methods This randomized prospective study was carried out on 100 patients complaining of acute abdominal pain diagnosed as appendicitis undergoing open or laparoscopic appendectomy operation in the general surgery department of Mataria Teaching Hospital, from February 2020 to August 2020. Clinical examination and laboratory workup were done to the population of the study according to the scoring systems (Alvarado and RIPASA scoring systems). Scoring was documented to every patient in the study preoperatively. The decision to operate was made by the senior surgeon (consultant), based on clinical and laboratory findings not depending on the results of the scoring systems. All patients received information about the surgical technique and risks of the operation and other options for treatment. All patients participated in this study after providing informed consent and the study was approved by the ethical committee of Ain Shams University. Results In our study, we found that RIPASA score was more sensitive (100 vs. 95%, respectively), and Alvarado score was more specific (38 vs. 0%, respectively). The positive predictive value for Alvarado score is significantly higher than that of RIPASA score (89 vs. 84%, respectively). The negative predictive value for Alvarado score is significantly higher than that of RIPASA score (60 vs. 0%, respectively). In our study, by using receiver operating characteristic, the area under the curve of Alvarado score is 0.924, which is greater than that for RIPASA scoring, which is 0.918. The difference in the area under the curves of 0.6% is significant between two scoring systems. The P value for these two variables in both the scores is less than 0.001, which shows that there is significant association between these values. Previous studies by Arroyo-Rangel and colleagues and Pasumarthi and Madhu found that the area under the curve of RIPASA score is greater than that for Alvarado score with P value less than 0.001 also. Conclusion Alvarado score was more specific and RIPASA scores were more sensitive. Alvarado score is shown to have a better diagnostic accuracy than RIPASA score. More trials with more number of patients should be conducted to reach an ideal score in the diagnosis of acute appendicitis. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of Alvarado score and the RIPASA score for acute appendicitis using histopathology as a gold standard. Study Design: Cross sectional validation study. Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Mar to Sep 2018. Methodology: A total number of 270 patients were included in the study presenting with pain right iliac fossa to the Accident and Emergency department. Surgeons and Seniors Residents in Surgery on call in the Accident and Emergency Department. Combined Military Hospital, Rawalpindi, scored the patients with suspicion of acute appendicitis with Alvarado Score and RIPASA score simultaneously. After appendectomy of these patients, the removed appendix was sent for histopathology to confirm whether it was normal or inflamed. A 2x2 table was used for calculating sensitivity, specificity and diagnostic accuracy of the RIPASA score and Alvarado Score. The two scoring systems were then compared for diagnostic accuracy. Results: In our study, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of RIPASA score and Alvarado score for diagnosing acute appendicitis were 92.1%, 62.1%, 95.2%, 48.6%, 88.9% and 72.6%, 68.9%, 95.1%, 23.2%, 72.2% respectively. Conclusion: The diagnostic accuracy of RIPASA score was more than that of Alvarado score in diagnosing acute appendicitis. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is one of the most common surgical emergencies, with a lifetime prevalence rate of approximately one in seven. Aim of the Work: to compare RIPASA score, (AIR) score and Modified Alvarado Score widely and easily used scoring systems, in order to identify which one is the best in sensitivity, specificity, positive predictive value, negative predictive value and accuracy, So which one leads to the most accurate diagnosis of acute Appendicitis. Patients and Methods: A randomized prospective study that was conducted in Ain-Shams University Hospitals. The study started in February 2022 till the number of cases is fulfilled. 50 patients presented with RT iliac fossa tenderness. Each patient was scored by the three scoring systems using history, examination, clinical labs. Results: 66.0% of cases were positive confirmed histology and (34.0%) cases were negative confirmed histology. There were highly statistically significant difference between Negative Confirmed histology and Positive Confirmed histology regarding RIPASA score, (AIR) score and Modified Alvarado Score. In this study, receiver operating characteristic curve (ROC) shows that the best cut off point of Modified Alvarado Score to detect Positive Modified Alvarado Score group was found >5 * with sensitivity of 87.88%, specificity of 64.71%, PPV of 82.9%, NPV of 73.3% and total accuracy of 77.0%. Conclusion: the Appendicitis Inflammatory Response score and Raja Isteri Pengiran Anak Saleha Appendicitis score have high discriminating powers and outperform the Modified Alvarado score. They could aid in selecting patients who require timely surgery or those who require further evaluation. Both these scores have the potential to turn out into scoring systems of choice if future research can substantiate our study findings. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the role of RIPASA scoring system for diagnosis of acute appendicitis taking histopathology as gold standard. Study Design: Prospective Study. Setting: Department of General Surgery, Nishter Hospital Multan. Period: February 2016 to February 2017. Material & Methods: One hundred and sixty 160 patients were included in this study. Study was started after ethical approval from ethical board of institution and informed consent from patients was taken. Non probability consecutive sampling was used. Main outcome variables were sensitivity, specificity and diagnostic accuracy of RIPASA score. SPSS version was used to analyze data. P value ≤ 0.05 was considered as significant. Results: Estimated sensitivity was 97.9%, which means that of the patients with acute appendicitis, 97.9% were diagnosed correctly. The estimated specificity was 76.9%, which means that of the patients not having acute appendicitis, 76.9% were diagnosed correctly. Positive predictive value was 86.1% and negative predictive value was 96.2%. The overall accuracy was 89.4% for diagnosing acute appendicitis. Conclusion: RIPASA scoring system is efficient, reliable and more diagnostic in cases of acute appendicitis. Abdominal ultrasonography is not suitable diagnostic tool to rule out negative appendectomy. [ABSTRACT FROM AUTHOR]

Background: Commonest surgical emergency presenting to emergency departments with abdominal pain is acute appendicitis. Thus, to enable quick and accurate diagnosis of the condition various scoring systems have been developed. Among these, Alvarado and its modified version (Modified Alvarado) are the commonest. Whereas Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score showed promising results in Asian population. Similarly, Lintula score, which was initially developed for paediatric population, has now been validated for elderly too. This study is aimed to compare these in our regional population. Method: Project included consecutive 125 clinically suspected acute appendicitis patients. All were scored using Modified Alvarado, RIPASA and Lintula systems. Final diagnosis was based on histopathologic evaluation of excised specimen. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were computed for all these systems by using SPSS statistical software and ROC curves were plotted. Results: With cut-off of 7, Modified Alvarado was 62% specific, 83% sensitive and 65% accurate. While PPV and NPV were 94% and 33%, respectively. Whereas RIPASA yielded better results, i.e., sensitivity of 98.4%, specificity of 87%, PPV of 97%, NPV of 77% and diagnostic accuracy of 92%. Whereas Lintula showed sensitivity of 71%, specificity of 87%, PPV of 96%, NPV of 40 and accuracy of 73%. Conclusion: RIPASA demonstrated higher sensitivity, PPV, NPV and diagnostic accuracy than Modified Alvarado and Lintula scores. Hence this study approves use of RIPASA score in the region. However further research on the subject is required to back this inference. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is one of the most common acute surgical emergencies on emergency room floor and timely diagnosis of the condition is of utmost importance. Multiple diagnostic Score exist to help in the clinical diagnosis; among Which RIPASA is a recent introduction. Methods: The study was carried out Ayub Teaching hospital of Abbottabad from Sept-2017 to Feb-2018, Department of General Surgery. The ultimate decision to perform surgery was not guided by the scores and the surgeon’s decision was the final word, and specimens were sent afterward for histopathology. The results compiled and entered into SPSS 20. Results: Out of the 308, 288 patients underwent surgery for AP, 165 (57.3%) were male and 123 (42.7%) were female, 252 (87.5%) had positive histopathology report and 36 (12.5%) had a negative report, with resultant negative appendectomy rate of 12.5% well below the average. 26 (9.02%) had a perforated appendix and 8 (2.8%) had post-op wound infection. The sensitivity of RIPASA score at a cut-off value of 7.5 was 98.02%, with specificity of 75%, and Positive Predictive Value of 96.48%, and Negative Predictive Value of 84.7%. Compared to Alvarado’s Score Sensitivity and Specificity of 53% and 75% respectively. Conclusion: On the balance the RIPASA Score detects early preventing from dreadful complication and in turn have low specificity giving way to a slightly higher negative appendectomy rate with the consequent morbidity and mortality of unnecessary surgery. Still RIPASA Score outperforms the Alvarado and Modified Alvarado Score. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of RIPASA and ALVARADO scoring system by taking histopathology as gold standard. Materials and Methods: This was a cross-sectional study in which total of 201 patients who were presented with right iliac fossa pain were enrolled. Non-probability sampling technique was employed. The RIPASA and ALVARA DO scores were derived and decisions based on clinical judgement was done. After appendectomies, resected appendix was sent for histopathological examination by consultant pathologist. SPSS version 23 was used for statistical analysis. Sensitivity, specificity, positive predicted value, negative predicted value & diagnostic accuracy were calculated. Results:At optimal cutoff threshold for RIPASA score=7.5, the sensitivity, specificity, positive predictive value, negative predictive value & diagnostic accuracy of the RIPASA scoring system were calculated as 100%, 96.23%, 98.67%, 100% & 99% respectively. Similarly, at optimal cutoff threshold for ALVARADOscore=7 the sensitivity, specificity, positive predictive value, negative predictive vale & diagnostic accuracy of the Alvarado scoring system were 95.95%, 92.45%, 97.26%, 89.09% and 95.02% respectively. Conclusion: RIPASA is more accurate and useful diagnosing tool for detection of appendicitis compared to ALVARADO. [ABSTRACT FROM AUTHOR]

Although acute appendicitis is one of the most common surgical emergencies worldwide, timely accurate diagnosis is always difficult for a surgeon even after availability of recent diagnostic tools. Our study is to determine validation of RIPASA score in diagnosis of acute appendicitis and histopathological correlation. A prospective study of 200 patients presented to emergency or surgical opd with right iliac fossa pain and suspected to have acute appendicitis were included in our study. RIPASA score calculated but appendectomy done on the basis of clinical assessment and hospital protocol and histopathological correlation done with a score. A score of 7.5 is cut off threshold, results compared with previous studies. In our study of 200 patients, M:F ratio of 1.56:1. Sensitivity of the RIPASA score was 95.89℅ with specificity 75.92% and diagnostic accuracy of 90.5%, expected and observed rate of negative appendectomy were 8.5 and 12.35%, respectively. So there is net reduction in negative appendectomy rate by 3.85%. Data analysis done with Statistical Package for Social Science (SPSS) version 21.0. RIPASA score at a cutoff value of 7.5 is easier, cheap, and better diagnostic tool in equivocal case of right iliac fossa pain in Indian scenario of limited availability of recent diagnostic tool in remote areas and affordability of these tool in the available set up, simultaneously, it also helps to reduce negative appendectomy rates. [ABSTRACT FROM AUTHOR]

BACKGROUND: Acute appendicitis is the most common surgical condition presented in emergency departments worldwide. Clinical scoring systems, such as the Alvarado and modified Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%-10%. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specifically for Asian populations. The aim of this study was to compare the modified Alvarado with the RIPASA scoring system in Kuwait population. METHODS: This study included 180 patients who underwent appendectomies and were documented as having "acute appendicitis" or "abdominal pain" in the operating theatre logbook (unit B) from November 2014 to March 2016. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic (ROC) curve of the modified Alvarado and RIPASA scoring systems were derived using SPSS statistical software. RESULTS: A total of 136 patients were included in this study according to our criteria. The cut-off threshold point of the modified Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specificity of 56%. The PPV was 89.3% and the NPV was 42.4%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded a 94.5% sensitivity and an 88% specifi city. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modifi ed Alvarado and RIPASA scoring systems, respectively. The negative appendectomy rate decreased significantly, from 18.4% to 10.7% for the modified Alvarado and to 2.2% for the RIPASA scoring system, which was a significant difference (P<0.001) for both scoring systems. CONCLUSION: Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specificity than the modified Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations. The RIPASA scoring system is more accurate and specific than the modified Alvarado scoring system for Kuwait population. [ABSTRACT FROM AUTHOR]

Aim: The definitive diagnosis of acute appendicitis (AA) requires histopathological examination. Various clinical diagnostic scoring systems attempt to reduce negative appendectomy rates. The most commonly used in Western Europe and the USA is the Alvarado score. The Raja Isteri Pengiran Anak Saleha appendicitis (RIPASA) score achieves better sensitivity and specificity in Asian and Middle Eastern populations. We aimed to determine the diagnostic accuracy of the RIPASA score in Irish patients with AA. Methods: All patients who presented to our institution with right iliac fossa pain and clinically suspected AA between January 1 and December 31, 2015, were indentified from our hospital inpatient enquiry database and retrospectively studied. Operating theatre records and histology reports confirmed those who underwent a non-elective operative procedure and the presence or absence of AA. SPSS version 22 was used for statistical analysis. Standard deviation is provided where appropriate. Results: Two hundred eight patients were included in the study (106/51% male, mean age 22.7 ± 9.2 years). One hundred thirty-five (64.9%) had histologically confirmed AA (mean symptom duration = 36.19 ± 15.90 h). At a score ≥7.5, the previously determined score most likely associated with AA in Eastern populations, the RIPASA scoring system demonstrated a sensitivity of 85.39%, specificity of 69.86%, positive predictive value of 84.06%, negative predictive value of 72.86% and diagnostic accuracy of 80% in our cohort. Conclusion: The RIPASA score is a useful tool to aid in the diagnosis of acute appendicitis in the Irish population. A score of ≥7.5 provides sensitivity and specificity exceeding that previously documented for the Alvarado score in Western populations. What does this paper add to the literature?: This is the first study evaluating the utility of the RIPASA score in predicting acute appendicitis in a Western population. At a value of 7.5, a cut-off score suggestive of appendicitis in the Eastern population, RIPASA demonstrated a high-sensitivity, specificity, positive predictive value and diagnostic accuracy in our cohort and was more accurate than the commonly used Alvarado score. [ABSTRACT FROM AUTHOR]

Background The diagnosis of acute appendicitis has remained difficult despite it being one of the most common surgical emergencies in the world. One of the most frequently used scoring systems is the Modified Alvarado Score (MAS). However, the MAS has been known to be less efficient in Asian populations. To overcome this issue, the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score has been specifically developed to improve the diagnosis of acute appendicitis in Asian populations. This study aimed to evaluate the accuracy of the RIPASA score compared to the MAS for the diagnosis of acute appendicitis in a Southeast Asian population keeping histopathology as the gold standard. Methodology The study group comprised 150 patients. Data were collected from each patient using a simple proforma to ascertain both the MAS and the RIPASA score for each patient at the time of presentation. The patients then underwent open appendectomy and histopathology was used as the gold standard to determine the presence or absence of acute appendicitis in the excised specimens. Results The RIPASA score had a sensitivity and specificity of 89.83% and 59.38%, respectively, compared to 64.41% and 53.12%, respectively, for the MAS. Diagnostic accuracy was similarly higher for the RIPASA score at 83.33% versus 62.00% for the MAS. Conclusions The RIPASA score is superior to the MAS for the diagnosis of acute appendicitis. Using the RIPASA score instead of the MAS in Southeast Asian populations can lead to a more accurate and timely clinical diagnosis of patients with suspected acute appendicitis and help improve patient outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mehbub et al.)

Objectives: This study aimed to compare Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado scoring to accurately identify acute appendicitis., Material and Methods: A cross-sectional prospective study was carried out in the department of surgery. Patients were enrolled and scored using RIPASA and Alvarado scoring systems. Appendectomy was done, and the specimen was sent for histopathology examination, which was used as the gold standard for diagnosis. Among 400 recruits, 11 patients were lost to follow-up, giving us a sample size of 389 patients. The cut-off value for RIPASA and Alvarado scores was 7.5 and 7.0, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy in diagnosing acute appendicitis of both scores were analyzed using SPSS., Results: Among 389 patients, 256 (66%) were males, and 277 (71%) were under the age of 40 years. RIPASA was more than 7.5 in 345 cases, while Alvarado was more than 7.0 in 261 patients. RIPASA score had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 95.8%, 87.9%, 98.9%, and 65.9%, respectively. In contrast, the ALVARADO score was 71.1% sensitive and 75.8% specific. RIPASA had a diagnostic accuracy of 95.12%, while Alvarado was only 71.46% accurate in diagnosing acute appendicitis., Conclusion: Compared to the Alvarado scoring system, RIPASA is a better tool in terms of accuracy, sensitivity, and specificity for diagnosing acute appendicitis., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare., (Copyright © 2023, Turkish Surgical Society.)

Acute appendicitis is a common but elusive surgical condition and remains a diagnostic dilemma. It has many clinical mimickers and diagnosis is primarily made on clinical grounds, leading to the evolution of clinical scoring systems for pin pointing the right diagnosis. The modified Alvarado and RIPASA scoring systems are two important scoring systems, for diagnosis of acute appendicitis. We prospectively compared the two scoring systems for diagnosing acute appendicitis in 50 patients presenting with right iliac fossa pain. The RIPASA score correctly classified 88 % of patients with histologically confirmed acute appendicitis compared with 48.0 % with modified Alvarado score, indicating that RIPASA score is more superior to Modified Alvarado score in our clinical settings. [ABSTRACT FROM AUTHOR]

The diagnosis of acute appendicitis is mainly clinical. Clinical scores like Alvarado, Modified Alvarado, Lintula, Tzanakis, AIRS (Appendicitis Inflammatory Response Score), Ohmann, Fenyo-Lindberg, and RIPASA (Raja Isteri Pengiran Anak Saleha Appendicitis) score have been developed to improve diagnostic ability and reduce negative appendicectomy rate. This study was undertaken to compare the diagnostic accuracy of these eight reported scoring systems. This was a prospective study on patients suspected to have acute appendicitis undergoing emergency appendicectomy. All the above eight scores were applied in all these patients and their diagnostic accuracy compared. The mean age of 70 patients was 32.13 SD 9.53 years, with equal male:female ratio. Most common symptom right lower abdominal pain, while most common sign was right iliac fossa tenderness. The highest sensitivity was seen with RIPASA score. Modified Alvarado, Ohmann, and AIR scores shared the highest specificity. The highest PPV was seen with Ohmann score. The highest NPV was seen with RIPASA score. Positive likelihood ratio (LR) was highest for Ohmann score. Negative LR was highest for AIR score. RIPASA score showed the highest diagnostic accuracy. Maximum area under the ROC curve was shown by both Alvarado and Modified Alvarado score. Of the eight clinical scoring systems, RIPASA has the highest diagnostic accuracy, sensitivity, and NPV. All scores have diagnostic accuracies which are either good or sufficient. Out of the 4 scores that do not require elaborate laboratory or radiological investigations (Modified Alvarado, Ohmann, Lintula, and Fenyo-Lindberg Score), Ohmann Score has the highest PPV, specificity, and positive LR. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is one of the most common emergency surgical condition. Diagnosis of acute appendicitis mostly use clinical evaluation and some laboratory investigation. There are two clinical scoring system has been used in diagnosis. The Alvarado score is the most popular one but has been reported low accuracy among the Asian population in some studies. Later, RIPASA score has been developed with better accuracy compared to Alvarado score in Asian group. Therefore, this study aimed to compare diagnostic accuracy between Alvarado score and RIPASA score in the Thai population. Materials and Methods: 163 consecutive patients who have clinical suspected of acute appendicitis were included to the study. Both Alvarado score and RIPASA score were applied to all patients prospectively. The histopathology of appendix in case of underwent appendectomy or clinical follow up one month without surgery was been used to analyzed with both scoring systems by cut off 7 for Alvarado score and 7.5 for RIPASA score which indicates a probable for acute appendicitis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value and accuracy of both scoring systems were evaluated. Results: Of 163 patients, 127 underwent appendectomy which 115 patients had histopathological confirmed diagnosis but 12 normal appendixes were reported and 36 patients were observed by clinical. Sensitivity, specificity, NPV, PPV and accuracy of Alvarado score were 83.5%, 62.5%, 61.2%, 84.2% and 80.2% respectively meanwhile they were 92.2%, 50%, 72.8%, 81.5% and 78.6% respectively for RIPASA score (pvalue <0.001 in all modalities). Conclusions: RIPASA score provided more sensitive than Alvarado score but gave less accuracy in diagnosis of acute appendicitis in the Thai population. [ABSTRACT FROM AUTHOR]

Objective: To compare Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado scores with multislice computed tomography (MSCT) for diagnosing acute appendicitis (AA)., Methods: This retrospective study included patients with abdominal pain who had undergone MSCT, and whose medical notes included RIPASA and Alvarado score parameters. MSCT was compared with RIPASA and Alvarado scores for diagnosing AA., Results: Of 297 patients included, sensitivity, specificity and accuracy for diagnosing AA were 95.2%, 73.6% and 87.2% for RIPASA score (cutoff value 7.5) and 63.1%, 80.9% and 69.7% for Alvarado score (cutoff value 7). Sensitivity, specificity and accuracy of MSCT for diagnosing AA were 98.9%, 96.4% and 98.0%, respectively. In terms of accuracy, statistically significant differences were observed between RIPASA and Alvarado scores, and between MSCT and RIPASA scores. The mean RIPASA score was significantly different in the simple AA group (9.7 ± 2.2) compared with other AA groups (10.5 ± 1.7). No statistically significant difference was observed in RIPASA score between nonperforated and perforated AA. MSCT sensitivity, specificity and accuracy for diagnosing simple AA were 94.1%, 96.4% and 95.8%, respectively; for differentiating perforated and nonperforated AA, scores were 90.2%, 95.2% and 94.1%, respectively., Conclusion: MSCT is the optimum diagnostic tool for AA, followed by RIPASA score and Alvarado score, particularly in diagnosing simple and perforated AA., (© The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)