Comparison of the Diagnostic Utility of Modified Alvarado and RIPASA Scoring Systems in Diagnosing Appendectomy at the University of Ilorin Teaching Hospital, Ilorin, Nigeria
Taofeeq Abdulrahman, Samuel Olatoke, Olayide Agodirin, Abdulrasheed Nasir, Alexander Gomna, Adewale Eletta, Adekunle Adedapo AbiodunAbstract
Background:
Acute appendicitis is mainly a clinical diagnosis, and a delay in diagnosis could result in serious complications with attendant morbidity and mortality that could be as high as 25%. This study aims to compare the efficacy of two appendicitis scoring systems: the modified Alvarado and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) in reducing negative appendectomy rate in patients with acute appendicitis.
Materials and Methods:
It was a prospective comparative study that was carried out at the University of Ilorin Teaching Hospital, Ilorin, Nigeria, on 48 patients from August 2018 to May 2019. Patients aged 16 years and above with suspected acute appendicitis who satisfied the inclusion criteria and, after obtaining their informed consent, were recruited for this study. A proforma was used to collect data.
Results:
A total of 48 patients had open appendectomy: 21 males (43.8%) and 27 females (56.2%). The age range was 18–46 years with a mean age of 26.9 years. Out of the 48 patients, 44 (91.7%) had acute appendicitis and 4 (8.3%) had a normal appendix at histology. The sensitivity, specificity, positive predictive value and negative predictive value for the two scoring tools were, 52.1%, 50.0%, 92.6% and 9.5% for modified Alvarado’s score (MAS) and 87.5%, 0.0%, 91.3% and 0.0% for RIPASA respectively.
Conclusion:
In this study of an African population with suspected uncomplicated acute appendicitis, the RIPASA score demonstrated higher sensitivity and diagnostic accuracy but lower specificity compared with the MAS. Overall, neither scoring tool effectively reduced the rate of negative appendectomies.