DIAGNOSIS OF ACUTE APPENDICITIS BY RIPASA SCORING SYSTEM AS AN OBSERVATIONAL STUDY

Introduction: Acute appendicitis is one of the most common cause of surgical emergency.Acute appendicitis can progress to perforation, which has high mortality and morbidity. Hence surgeons are inclined to operate rather than waiting when the diagnosis is probable¹. When presenting in a teenager and with a classical history, presents the Surgeon with little by way of a diagnostic challenge.

Method:It was a prospective observational study of “Clinical evaluation of RIPASA scoring system in the diagnosis of acute appendicitis” was carried out in the department of general surgery, Acharya Vinoba Bhave Rural Hospital, affiliated to Jawaharlal Nehru Medical College, Sawangi, Wardha, from April 2012 to September 2014. Total 80 patient was included in this study.

Result:The most common position of appendix as found in our study was retro-caecal and the least common position was pre-ileal.We found that in our study sensitivity was 96%, specificity was 65%, positive predictive value was 67%, negative predictive value was 86% and diagnostic accuracy was 70%. The cut-off value, we have taken is 7.5. As compared to the study done by Chong CF et al¹⁸ in2011, our sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 2% less, 16.3% less, 18.3% less, 11.4% less and 21.8% less respectively [Table 5].ROC plots for the RIPASA scoring system. The optimal cut-offthreshold score is 7.5, with a sensitivity and specificity of 0.96 and 0.65 (1-specificity= 0.35) respectively. The positive predictive value and negative predictivevalue are 0.67 and 0.86respectively.The diagnostic accuracy of the study being 70%.So according to the above table we are taking:True positive = 44, True negative = 22, Hence,True positive + true negative divided by total number of patients44 + 22 = 66 / 80 = 70% is the diagnostic accuracy.

Conclusion:The RIPASA score is simple scoring system with high sensitivity and specificity for the diagnosis of acute appendicitis .RIPASA score is currently a better diagnostic scoring system for diagnosis of acute appendicitis compared to OTHER particularly in Indian population. Making a correct and prompt diagnosis of acute appendicitis including its possible pathological stage is possible with the RIPASA score, which is easily obtained using simple clinical and laboratory data, without a need of unwanted admissions and expensive imaging studies like CT scan.