Evaluation of modifi ed Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis

摘要

BACKGROUND： Acute appendicitis is the most common surgical condition presented inemergency departments worldwide. Clinical scoring systems, such as the Alvarado and modifiedAlvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to5%-10%. The Raja Isteri Pengiran Anak Saleha Appendicitis （RIPASA） scoring system was establishedin 2008 specifi cally for Asian populations. The aim of this study was to compare the modifi ed Alvaradowith the RIPASA scoring system in Kuwait population.METHODS： This study included 180 patients who underwent appendectomies and weredocumented as having ＂acute appendicitis＂ or ＂abdominal pain＂ in the operating theatre logbook （unitB） from November 2014 to March 2016. The sensitivity, specificity, positive predictive value （PPV）,negative predictive value （NPV）, diagnostic accuracy, predicted negative appendectomy and receiveroperating characteristic （ROC） curve of the modified Alvarado and RIPASA scoring systems werederived using SPSS statistical software.RESULTS： A total of 136 patients were included in this study according to our criteria. The cut-offthreshold point of the modifi ed Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% anda specifi city of 56%. The PPV was 89.3% and the NPV was 42.4%. The cut-off threshold point of theRIPASA score was set at 7.5, which yielded a 94.5% sensitivity and an 88% specifi city. The PPV was97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2%for the modifi ed Alvarado and RIPASA scoring systems, respectively. The negative appendectomy ratedecreased signifi cantly, from 18.4% to 10.7% for the modifi ed Alvarado, and to 2.2% for the RIPASAscoring system, which was a signifi cant difference （P〈0.001） for both scoring systems.CONCLUSION： Based on the results of this study, the RIPASA score is a simple scoring systemwith better sensitivity and specifi city than the modifi ed Alvarado scoring system in Asian populations. Itconsists of 14 clinical parameters that can be obtained from a good patient history, clinical examinationand laboratory investigations. The RIPASA scoring system is more accurate and specific than themodifi ed Alvarado scoring system for Kuwait population.