Comparison of the Alvarado, Acute Inflammatory Response (AIR) and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) Scoring Systems for Diagnosing Acute Appendicitis.

Acute appendicitis is one of the most common causes of an acute abdomen. Early recognition of the condition and prompt operation has been the most important factors in reducing morbidity and mortality. On the other hand, removing a normal appendix is a burden both on patients and health resources. Several scoring systems have been used to aid in early diagnosis of acute appendicitis and its prompt management. Recently, the Alvarado, the acute inflammatory response (AIR) and the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring systems have been the more common clinical diagnostic scoring systems used for the diagnosis of acute appendicitis. The study was performed to identify the scoring system having best predictive values for diagnosing acute appendicitis. Objective of the study was to compare the predictive values of Alvarado, AIR and RIPASA scoring systems for diagnosing acute appendicitis. This study was conducted in the department of Surgery of Shaheed Suhrawardy Medical College & Hospital, Bangladesh from June 2020 to May 2021. A total number of one hundred (100) patients were included in the study. This study prospectively compared the RIPASA, Alvarado and AIR systems by applying them to 100 patients. All the scores were calculated for patients who presented with acute appendicitis and underwent appendicectomy. Then the scores of RIPASA, Alvarado and AIR scoring systems were compared respectively. The mean age of the patients was 28.0±12.30 years with a male: female ratio of 1.08:1. Eighty nine (89) patients were positive for acute appendicitis. RIPASA scoring system had a better sensitivity (95.51%) than Alvarado (89.89%) and AIR (92.89%). Specificity was more in RIPASA (85.82%) than Alvarado (63.64%) and AIR (81.82%). Statistically significant difference (p<0.05) is found in the difference of area under curves (AUC) of Receiver Operating Characteristic (ROC) curve of RIPASA (0.960), Alvarado (0.809) and AIR (0.864) scoring systems. The study concluded that the RIPASA scoring can be effectively conducted for the better evaluation of acute appendicitis which holds promise as an improved cost effective way of diagnosis.