Publication:

Reducing negative appendectomies: a prospective comparative study of the RIPASA and Alvarado scoring systems in the emergency setting in an Indian population cohort

Background Acute appendicitis is the most common surgical emergency worldwide, with a reported lifetime prevalence of approximately 7–12%. Clinical scoring systems offer a rapid, cost-effective adjunct to diagnosis, yet conventional tools such as the Alvarado score exhibit suboptimal sensitivity, particularly in Asian populations. The RIPASA (Raja Isteri Pengiran Anak Saleha Appendicitis) score, incorporating six additional parameters including age, sex duration of symptoms, was developed specifically to address this limitation.

Methods A prospective observational comparative study was conducted in the Surgery Department of KPC Medical College and Hospital, Kolkata, India, from December 2022 to June 2024 (18 months). Fifty-one adult patients (aged ≥12 years) presenting with right iliac fossa pain were prospectively enrolled. Both the Alvarado and RIPASA scores were applied at presentation. Definitive diagnosis was established by histopathological examination (HPE) of appendectomy specimens or clinical follow-up. Diagnostic performance metrics sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) overall accuracy were calculated using standard 2×2 contingency tables. Statistical significance was assessed by chi-square test and z-test (SPSS v27).

Results RIPASA demonstrated superior sensitivity (83.3% vs 66.7%), specificity (80.0% vs 66.7%), NPV (66.7% vs 45.5%) accuracy (82.35% vs 66.66%) compared to Alvarado. The chi-square statistic for RIPASA was 18.60 (p<0.0001) versus 4.80 (p=0.029) for Alvarado. The potential negative appendectomy rate with the RIPASA cut-off was 66.7% lower than with the Alvarado system.

Conclusions The RIPASA score is a superior clinical diagnostic tool for acute appendicitis in the emergency setting, particularly in Asian populations. Its adoption in Indian emergency departments has the potential to significantly reduce negative appendectomy rates, associated morbidity healthcare costs.