Assessment of the RIPASA Score in the Diagnosis of Acute Appendicitis in Khartoum State Hospitals, Sudan
DOI:
https://doi.org/10.31964/mltj.v0i0.427Keywords:
Acute appendicitis, appendectomy, histopathology, RIPASA scoreAbstract
Appendectomy is a common cause of emergency hospitalization, and appendectomy is one of the most common emergency procedures performed in modern medicine. Although it is a common problem, acute appendicitis remains a complex condition to diagnose, especially in the young, the elderly, and women of childbearing age. The aim was to evaluate the accuracy of the RIPASA score for patients with right iliac fossa pain (RIF) and suspected appendicitis. This study is an observational, analytic, and prospective cohort study conducted for one year. All patients suspected of having acute appendicitis and who underwent appendectomy were included in this study. All resected appendages were sent for histological examination. RIPASA scores were calculated for all patients. The study results in the 105 patients studied, 60 (57.1%) were predominantly male. The M/F ratio is 1.3/1. Most of the 98 patients (93.3%) were 40 years old. Most patients had symptoms within 48 hours 79 (75.2%). The most common symptom was anorexia (83.8%). All patients had RIF tenderness (100%). 95 (90.5%) patients had a score >7.5. On gross examination, three patients (2.9%) had a non-inflammatory appendix, 83 patients (79.0%) had a simple inflammatory appendix, the perforated appendix was found in 9 patients (8.6%), appendix mass was found in 6 patients (5,7%), and only four patients (3.8%) had an appendiceal abscess. The appendix was histologically inflamed in 69 patients (65.7%). The sensitivity of the RIPASA scoring system in our study was 69.5%, and the specificity was 70%. The diagnostic accuracy was calculated and was 69.5%. Our study's positive and negative predictive values (PPV, NPV) were 95.7% and 19.4%, respectively. Research conclusion RIPASA value of 7.5 is beneficial and easy to use. Therefore, surgeons can use it as a diagnostic guide for acute appendicitis to reduce the rate of misdiagnosis.References
Addiss, D. G. et al. (1990). The epidemiology of appendicitis and appendectomy in the United States. American journal of epidemiology, 132(5), 910–925.
Ahmed, M. E. (1987). Acute appendicitis in Khartoum: pattern and clinical presentation. East African medical journal, 64(3), 202–206.
Al-Hashemy, A. M. and Seleem, M. I. (2004). Appraisal of the modified Alvarado score for acute appendicitis in adults. Saudi Med J, 25(9), 1229–1231.
Alvarado, A. (1986). A practical score for the early diagnosis of acute appendicitis. Annals of emergency medicine, 15(5), pp. 557–564.
Bower, R. J., Bell, M. J. and Ternberg, J. L. (1981). Diagnostic value of the white blood count and neutrophil percentage in the evaluation of abdominal pain in children. Surgery, gynecology & obstetrics, 152(4), 424–426.
Burkitt, D. P. (1971). The aetiology of appendicitis. Journal of British Surgery, 58(9), 695–699.
Butt, M. Q. et al. (2014). RIPASA score: a new diagnostic score for diagnosis of acute appendicitis. J Coll Physicians Surg Pak, 24(12), 894–897.
Chong, C. F. et al. (2010). Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis. Singapore medical journal, 51(3), 220.
Chong, C. F. et al. (2011). Comparison of RIPASA and Alvarado scores for the diagnosis of acute appendicitis. Singapore medical journal, 52(5), 340.
Cuschieri, A. (2015). Disorders of the small intestine and vermiform appendix. in Essential Surgical Practice. CRC Press, pp. 872–947.
Díaz-Barrientos, C. Z. et al. (2018). The RIPASA score for the diagnosis of acute appendicitis: A comparison with the modified Alvarado score. Revista de Gastroenterología de México (English Edition), 83(2), 112–116.
Humes, D. J. and Simpson, J. (2006). Acute appendicitis. Bmj, 333(7567), 530–534.
Kalan, M. et al. (1994). Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Annals of the Royal College of Surgeons of England, 76(6), 418.
Khan, I. and ur Rehman, A. (2005). Application of Alvarado scoring system in diagnosis of acute appendicitis. Journal of Ayub Medical College Abbottabad, 17(3).
Mike, K. L. et al. (2015). Appendix. Schwartz’s Principles of Surgery. F. Charles Brunicardi, et al. McGraw- Cuschieri Hill Education, 30, pp. 1243–1250.
Nanjundaiah, N. et al. (2014). A comparative study of RIPASA Score And ALVARADO score in the diagnosis of acute appendicitis. Journal of clinical and diagnostic research: JCDR, 8(11), NC03.
Noor, S. et al. (2020). Comparing Ripasa score and Alvarado score in an accurate diagnosis of acute appendicitis. Journal of Ayub Medical College Abbottabad, 32(1), 38–41.
Nwokoma, N. J. (2012). Appendicitis in children. Appendicitis: A Collection of Essays from Around the World, p. 133.
Ohmann, C., Yang, Q. and Franke, C. (1995). Diagnostic scores for acute appendicitis. Abdominal Pain Study Group. The European journal of surgery; Acta chirurgica, 161(4), 273–281.
Pasumarthi, V. and Madhu, C. P. (2018). A comparative study of RIPASA score and ALVARADO score in diagnosis of acute appendicitis. International Surgery Journal, 5(3), 796–801.
Rodrigues, G., Rao, A. and Khan, S. A. (2006). Evaluation of Alvarado score in acute appendicitis: a prospective study. The Internet Journal of Surgery, 9(1), 1–5.
Singh, A. et al. (2018). To determine validation of RIPASA score in diagnosis of suspected acute appendicitis and histopathological correlation with applicability to Indian population: a single institute study. Indian Journal of Surgery, 80(2), 113–117.
Ahmed, M. E. (1987). Acute appendicitis in Khartoum: pattern and clinical presentation. East African medical journal, 64(3), 202–206.
Al-Hashemy, A. M. and Seleem, M. I. (2004). Appraisal of the modified Alvarado score for acute appendicitis in adults. Saudi Med J, 25(9), 1229–1231.
Alvarado, A. (1986). A practical score for the early diagnosis of acute appendicitis. Annals of emergency medicine, 15(5), pp. 557–564.
Bower, R. J., Bell, M. J. and Ternberg, J. L. (1981). Diagnostic value of the white blood count and neutrophil percentage in the evaluation of abdominal pain in children. Surgery, gynecology & obstetrics, 152(4), 424–426.
Burkitt, D. P. (1971). The aetiology of appendicitis. Journal of British Surgery, 58(9), 695–699.
Butt, M. Q. et al. (2014). RIPASA score: a new diagnostic score for diagnosis of acute appendicitis. J Coll Physicians Surg Pak, 24(12), 894–897.
Chong, C. F. et al. (2010). Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis. Singapore medical journal, 51(3), 220.
Chong, C. F. et al. (2011). Comparison of RIPASA and Alvarado scores for the diagnosis of acute appendicitis. Singapore medical journal, 52(5), 340.
Cuschieri, A. (2015). Disorders of the small intestine and vermiform appendix. in Essential Surgical Practice. CRC Press, pp. 872–947.
Díaz-Barrientos, C. Z. et al. (2018). The RIPASA score for the diagnosis of acute appendicitis: A comparison with the modified Alvarado score. Revista de Gastroenterología de México (English Edition), 83(2), 112–116.
Humes, D. J. and Simpson, J. (2006). Acute appendicitis. Bmj, 333(7567), 530–534.
Kalan, M. et al. (1994). Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Annals of the Royal College of Surgeons of England, 76(6), 418.
Khan, I. and ur Rehman, A. (2005). Application of Alvarado scoring system in diagnosis of acute appendicitis. Journal of Ayub Medical College Abbottabad, 17(3).
Mike, K. L. et al. (2015). Appendix. Schwartz’s Principles of Surgery. F. Charles Brunicardi, et al. McGraw- Cuschieri Hill Education, 30, pp. 1243–1250.
Nanjundaiah, N. et al. (2014). A comparative study of RIPASA Score And ALVARADO score in the diagnosis of acute appendicitis. Journal of clinical and diagnostic research: JCDR, 8(11), NC03.
Noor, S. et al. (2020). Comparing Ripasa score and Alvarado score in an accurate diagnosis of acute appendicitis. Journal of Ayub Medical College Abbottabad, 32(1), 38–41.
Nwokoma, N. J. (2012). Appendicitis in children. Appendicitis: A Collection of Essays from Around the World, p. 133.
Ohmann, C., Yang, Q. and Franke, C. (1995). Diagnostic scores for acute appendicitis. Abdominal Pain Study Group. The European journal of surgery; Acta chirurgica, 161(4), 273–281.
Pasumarthi, V. and Madhu, C. P. (2018). A comparative study of RIPASA score and ALVARADO score in diagnosis of acute appendicitis. International Surgery Journal, 5(3), 796–801.
Rodrigues, G., Rao, A. and Khan, S. A. (2006). Evaluation of Alvarado score in acute appendicitis: a prospective study. The Internet Journal of Surgery, 9(1), 1–5.
Singh, A. et al. (2018). To determine validation of RIPASA score in diagnosis of suspected acute appendicitis and histopathological correlation with applicability to Indian population: a single institute study. Indian Journal of Surgery, 80(2), 113–117.
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Published
2022-06-27
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Ahmed, M. H. Y., Hamza, A. A., Mohammed Mansour, A., & Abuaagla, K. Y. (2022). Assessment of the RIPASA Score in the Diagnosis of Acute Appendicitis in Khartoum State Hospitals, Sudan. Medical Laboratory Technology Journal, 8(1), 42–51. https://doi.org/10.31964/mltj.v0i0.427
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