title: A Comparative Study of RIPASA Score and ALVARADO Score in the Diagnosis of Acute Appendicitis.
abstract: BACKGROUND
  Acute appendicitis is one of the most common surgical emergencies. Different techniques have been devised to assist in equivocal cases in attempts to decrease negative appendicectomy rates. A number of scoring systems have been used for aiding in early diagnosis of acute appendicitis and its prompt management of which Alvarado score is the most popular. The accuracy of Alvarado score in the diagnosis of acute appendicitis is disappointingly low in Asian population and RIPASA scoring has been designed for the diagnosis of acute appendicitis in the Asian population. So we prospectively applied and compared Alvarado and RIPASA score in the diagnosis of acute appendicitis in Indian population.
  
  
  METHODS
  We compared prospectively RIPASA and Alvarado scoring system by applying them to 206 patients. Both scores were calculated for patients who presented with right iliac fossa pain during the study period. Depending on clinical judgment appendicectomy was done. Post operative histopathology report was correlated with the scores. A score of 7.5 is the optimal cut off threshold for RIPASA and 7 for Alvarado scoring system. Sensitivity, specificity, positive predictive value (PPV) and negative predictive (NPV) for RIPASA & Alvarado system was done.
  
  
  RESULTS
  The sensitivity and specificity of RIPASA score were 96.2% and 90.5% respectively. The sensitivity and specificity of Alvarado score were 58.9% and 85.7% respectively. RIPASA score correctly classified 96 percent of all patients confirmed with histological acute appendicitis to the high probability group (RIPASA score greater than 7.5) compared with 58.9% with Alvarado score (Alvarado score greater than 7.0; p-value less than 0.001).
  
  
  CONCLUSIONS
  RIPASA scoring system is more convenient, accurate, and specific scoring system for Indian population than Alvarado scoring system.
authors.affiliation: Post Graduate, Department of General Surgery, KMC , Mangalore, Karnataka, India .
authors.forename: Nanjundaiah
authors.initials: N
authors.lastname: N
authors.affiliation: Associate Professor, Department of General Surgery, KMC , Mangalore, Karnataka, India .
authors.forename: Ashfaque
authors.initials: A
authors.lastname: Mohammed
authors.affiliation: Assistant Professor, Department of General Surgery, KMC , Mangalore, Karnataka, India .
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Shanbhag
authors.affiliation: Associate Professor, Deparment of Physiology, A.J Institute of Medical Sciences , Karnataka, India .
authors.forename: Kalpana
authors.initials: K
authors.lastname: Ashfaque
authors.affiliation: Assistant Professor, Deparment of Physiology, SDM Medical College , Dharwad, India .
authors.forename: Priya
authors.initials: P
authors.lastname: S A
keywords: Acute appendicitis; Alvarado; RIPASA