title: RIPASA score: a new diagnostic score for diagnosis of acute appendicitis.
abstract: OBJECTIVE
  To determine the usefulness of RIPASA score for the diagnosis of acute appendicitis using histopathology as a gold standard.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Department of General Surgery, Combined Military Hospital, Kohat, from September 2011 to March 2012.
  
  
  METHODS
  A total of 267 patients were included in this study. RIPASA score was assessed. The diagnosis of appendicitis was made clinically aided by routine sonography of abdomen. After appendicectomies, resected appendices were sent for histopathological examination. The 15 parameters and the scores generated were age (less than 40 years = 1 point; greater than 40 years = 0.5 point), gender (male = 1 point; female = 0.5 point), Right Iliac Fossa (RIF) pain (0.5 point), migration of pain to RIF (0.5 point), nausea and vomiting (1 point), anorexia (1 point), duration of symptoms (less than 48 hours = 1 point; more than 48 hours = 0.5 point), RIF tenderness (1 point), guarding (2 points), rebound tenderness (1 point), Rovsing's sign (2 points), fever (1 point), raised white cell count (1 point), negative urinalysis (1 point) and foreign national registration identity card (1 point). The optimal cut-off threshold score from the ROC was 7.5. Sensitivity analysis was done.
  
  
  RESULTS
  Out of 267 patients, 156 (58.4%) were male while remaining 111 patients (41.6%) were female with mean age of 23.5 ± 9.1 years. Sensitivity of RIPASA score was 96.7%, specificity 93.0%, diagnostic accuracy was 95.1%, positive predictive value was 94.8% and negative predictive value was 95.54%.
  
  
  CONCLUSIONS
  RIPASA score at a cut-off total score of 7.5 was a useful tool to diagnose appendicitis, in equivocal cases of pain.
authors.affiliation: Department of General Surgery, Combined Military Hospital, Kohat.
authors.forename: Muhammad Qasim
authors.initials: MQ
authors.lastname: Butt
authors.affiliation: Department of General Surgery, Combined Military Hospital, Kohat.
authors.forename: Sohail Saqib
authors.initials: SS
authors.lastname: Chatha
authors.affiliation: Department of General Surgery, Military Hospital, Rawalpindi.
authors.forename: Adeel Qamar
authors.initials: AQ
authors.lastname: Ghumman
authors.affiliation: Department of General Surgery, Jinnah Hospital, Lahore.
authors.forename: Mahwish
authors.initials: M
authors.lastname: Farooq
mesh_terms: D000006:Abdomen, Acute / Q000000981:diagnostic imaging / Q000209:etiology*; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017699:Pelvic Pain / Q000175:diagnosis; D011237:Predictive Value of Tests; D011859:Radiography; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014839:Vomiting / Q000209:etiology; D055815:Young Adult