Comparison of The Predictive Accuracy of RIPASA Score in Identifying Acute Appendicitis to The Gold Standard of Histo-Pathologically Confirmed Appendicitis

Abstract

Objective: The goal of this study was to compare the predictive accuracy of RIPASA score in diagnosing acute appendicitis with the gold standard of histo-pathologically proven appendicitis as gold standard.

Methodology: This prospective cohort study was conducted in CMH Hospital from Sep 2022 to March 2023. 208 patients over the age of 16 who were sent to the on-call surgeon for treatment of acute RIF pain or suspicion of appendicitis were included in our study. The clinical data of patients was gathered using standardized case report forms during examination.

Patients were divided into two groups a histologically proven AA diagnosis; & a non-appendicitis diagnosis.

Chi-square test was applied to evaluate both the groups keeping significance less than 0.05. Sensitivity and specificity of RIPASA scoring wasassessed comparing Appendicitis on Histology.

Results: Results showed that 81% of patients had positive histopathology results for appendicitis, while 19% were negative. Using a cutoff RIPASA score of >=7.5, 71% of patients were positive, and for a score <7.5, 29% were negative. There was a significant association (p-value = 0.001) between histopathology results and RIPASA scores, demonstrating a sensitivity of 76.2% and specificity of 52.5% in identifying acute appendicitis. The positive predictive value (PPV) was 87.03%, and the negative predictive value (NPV) was 34.4%.

Conclusion:  The findings indicated lower sensitivity and specificity compared to previous studies, questioning the significance of the RIPASA score as a standalone diagnostic tool. Incorporating imaging modalities and considering age-specific criteria may enhance diagnostic accuracy.