Authors :
Dr. Chukwuemeka Emmanuel Onyedi; Stephen Ekundayo Garba; Dr. George OnuIllah
Volume/Issue :
Volume 9 - 2024, Issue 2 - February
Google Scholar :
http://tinyurl.com/2k5tvv46
Scribd :
http://tinyurl.com/5n62rb6x
DOI :
https://doi.org/10.5281/zenodo.10638498
Abstract :
Introduction: The incidence of Acute appendicitis, a
major cause of acute abdomen, in Africa is low but is
said to be progressively increasing. Accurate diagnosis of
acute appendicitis, amidst different clinical conditions
that mimic it, is challenging and fraught with pitfalls.
Clinical scoring systems, developed to aid prompt
diagnosis, prevent possible perforations with its
challenges and limit negative appendectomies, play a
pivotal role in Sub-Saharan Africa where paucity of
funds abounds, and novel investigation modalities are
lacking. The Alvarado scoring system, the first of such
aids, is reported to have varying diagnostic outcomes
alongside high perforation rates in sub-Saharan Africa
compared to other climes. Better diagnostic tools are still
being sought after, and a new scoring system, the Raja
Isteri Pengiran Anak Saleha Appendicitis (RIPASA), was
compared with Alvarado to bridge this gap and solve this
challenge at the University of Abuja Teaching Hospital
(UATH), Gwagwalada.
Objective: To prospectively determine and compare the
diagnostic accuracy, specificity, and sensitivity of the
RIPASA and Alvarado scoring systems in the diagnosis
of acute appendicitis.
Patients and Methods: A One-year prospective
comparative cross-sectional study in which seventy-nine
patients between 7-62 years of age, of both sexes,
presenting with pain in the right lower abdominal
quadrant and suspected to have acute appendicitis were
enrolled. Each patient’s clinical details, alongside their
Alvarado and RIPASA scores, were obtained at
presentation and a decision for surgery was exclusively
based on the clinical findings and the investigations.
Only seventy-six patients had surgery based on clinical
assessment and these patients were correlated with the
histologic diagnoses. Data collated was analyzed using
SPSS 25 and the diagnostic accuracy, sensitivity,
specificity, positive predictive values (PPV), negative
predictive values (NPV) and negative appendectomy
rates (NAR) of the scoring systems were determined.
Results: The sensitivity, specificity, PPV, NPV and
diagnostic accuracy of RIPASA was 97.1%, 71.4%,
97.1%, 71.4% and 94.7% respectively while Alvarado
had sensitivity, specificity, PPV, NPV and diagnostic
accuracy of 66.7%, 57.1%, 93.9%, 14.8% and 65.8%
respectively. The negative appendectomy rate (NAR)
based on clinical evaluation was 9.2%.
Conclusion: The RIPASA scoring system outperforms
the Alvarado scoring system as a diagnostic tool for
acute appendicitis. Surgery decisions can be influenced
by the RIPASA grading system, and this can help avoid
unnecessary procedures.
Keywords :
Acute Appendicitis, RIPASA Scores, Alvarado Scores, Diagnostic Accuracy, Negative Appendectomy, Sensitivity, Specificity.
Introduction: The incidence of Acute appendicitis, a
major cause of acute abdomen, in Africa is low but is
said to be progressively increasing. Accurate diagnosis of
acute appendicitis, amidst different clinical conditions
that mimic it, is challenging and fraught with pitfalls.
Clinical scoring systems, developed to aid prompt
diagnosis, prevent possible perforations with its
challenges and limit negative appendectomies, play a
pivotal role in Sub-Saharan Africa where paucity of
funds abounds, and novel investigation modalities are
lacking. The Alvarado scoring system, the first of such
aids, is reported to have varying diagnostic outcomes
alongside high perforation rates in sub-Saharan Africa
compared to other climes. Better diagnostic tools are still
being sought after, and a new scoring system, the Raja
Isteri Pengiran Anak Saleha Appendicitis (RIPASA), was
compared with Alvarado to bridge this gap and solve this
challenge at the University of Abuja Teaching Hospital
(UATH), Gwagwalada.
Objective: To prospectively determine and compare the
diagnostic accuracy, specificity, and sensitivity of the
RIPASA and Alvarado scoring systems in the diagnosis
of acute appendicitis.
Patients and Methods: A One-year prospective
comparative cross-sectional study in which seventy-nine
patients between 7-62 years of age, of both sexes,
presenting with pain in the right lower abdominal
quadrant and suspected to have acute appendicitis were
enrolled. Each patient’s clinical details, alongside their
Alvarado and RIPASA scores, were obtained at
presentation and a decision for surgery was exclusively
based on the clinical findings and the investigations.
Only seventy-six patients had surgery based on clinical
assessment and these patients were correlated with the
histologic diagnoses. Data collated was analyzed using
SPSS 25 and the diagnostic accuracy, sensitivity,
specificity, positive predictive values (PPV), negative
predictive values (NPV) and negative appendectomy
rates (NAR) of the scoring systems were determined.
Results: The sensitivity, specificity, PPV, NPV and
diagnostic accuracy of RIPASA was 97.1%, 71.4%,
97.1%, 71.4% and 94.7% respectively while Alvarado
had sensitivity, specificity, PPV, NPV and diagnostic
accuracy of 66.7%, 57.1%, 93.9%, 14.8% and 65.8%
respectively. The negative appendectomy rate (NAR)
based on clinical evaluation was 9.2%.
Conclusion: The RIPASA scoring system outperforms
the Alvarado scoring system as a diagnostic tool for
acute appendicitis. Surgery decisions can be influenced
by the RIPASA grading system, and this can help avoid
unnecessary procedures.
Keywords :
Acute Appendicitis, RIPASA Scores, Alvarado Scores, Diagnostic Accuracy, Negative Appendectomy, Sensitivity, Specificity.
