COMPARATIVE EVALUATION OF RIPASA AND ALVARADO SCORING SYSTEMS IN PREDICTING ACUTE APPENDICITIS: A PROSPECTIVE OBSERVATIONAL CASE SERIES

Abstract

Background: Acute appendicitis is the most common cause of acute abdomen requiring emergency surgery, with a lifetime risk of 6–7% [1,2]. Although the Alvarado score is widely used for preoperative risk stratification, its diagnostic accuracy has been shown to be limited in Asian populations [3,4]. The RIPASA score, developed in 2010 specifically for Asian demographics, incorporates additional clinical and demographic variables and has demonstrated superior diagnostic performance in several validation studies [5,6]. Objective: To compare the diagnostic accuracy of the RIPASA and Alvarado scoring systems against histopathologically confirmed intraoperative findings in patients undergoing appendectomy for suspected acute appendicitis. Methods: This prospective observational case series was conducted at the Department of General Surgery, Sree Balaji Medical College and Hospital, Chennai, India, from July 2024 to January 2026. Ninety consecutive patients aged ≥18 years presenting with clinical features suggestive of acute appendicitis and scheduled for appendectomy were enrolled. Both scoring systems were calculated preoperatively and correlated with histopathological findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, and receiver operating characteristic (ROC) curve analyses were performed [7]. Results: The mean age of the cohort was 34.2 years, with male predominance (62.2%). Histopathological examination confirmed acute appendicitis in 76 patients (84.4%), yielding a negative appendectomy rate of 15.6%. The RIPASA score (≥7.5) demonstrated sensitivity of 78.9%, specificity of 71.4%, PPV of 93.8%, NPV of 38.5%, and diagnostic accuracy of 77.8% (AUC = 0.80). The Alvarado score (≥7) showed sensitivity of 60.5%, specificity of 57.1%, PPV of 88.5%, NPV of 21.1%, and diagnostic accuracy of 60.0% (AUC = 0.62). All differences were statistically significant (p < 0.05) [8]. Conclusion: The RIPASA scoring system demonstrated superior diagnostic accuracy compared to the Alvarado score in this Indian cohort. Integration of the RIPASA score into emergency department protocols may reduce negative appendectomy rates and improve clinical decision-making in resource-limited settings [9,10].