A Comparative Study of Modified Alvarado Scoring and Raja Isteri Pengiran Anak Saleha Appendicitis Scoring Systems for the Diagnosis of Acute Appendicitis

Abstract

Background: Acute appendicitis is one of the most common surgical emergencies, with a lifetime prevalence rate of approximately one in seven. There have been various scoring systems developed, of which Alvarado and modified Alvarado scores have been used commonly, but both have low diagnostic value when used in Middle Eastern and Asian populations. Different techniques have been devised to assist in equivocal cases in attempts to decrease negative appendicectomy rates. In the present study, Modified Alvarado Scoring System (MASS) and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) are compared amongst the local population in Kerala, to find out which scoring system is more relevant and applicable, in order to aid early diagnosis of acute appendicitis. Materials and Methods: This is a prospective study which included 125 patients for a period of 13 months from November 2020 to December 2021. Results: The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MASS score were 62.11%, 60.00%, 83.10% and 33.33%, respectively. The sensitivity, specificity, PPV and NPV of RIPASA score were 90.53%, 76.67%, 92.47% and 71.88%, respectively. The diagnostic accuracy of MASS and RIPASA scoring systems was 61.6% and 87.2%, respectively. The results indicate that RIPASA scoring system is a better diagnostic tool for diagnosing acute appendicitis. Conclusions: Based on this study, RIPASA scoring system is more accurate and specific than MASS in diagnosing acute appendicitis.