Department of Surgery, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BA 1710, Brunei Darussalam.
Singapore Med J. 2011 May;52(5):340-5.
The accuracy of the Alvarado score in diagnosing acute appendicitis in an Asian population has been disappointingly low. We prospectively compared the RIPASA score with the Alvarado score for the diagnosis of acute appendicitis.
200 consecutive patients who presented to the Accident and Emergency Department with right iliac fossa pain were recruited in the study. Both the RIPASA and Alvarado scores were derived, but decisions for appendicectomy were based on clinical judgement. Receiver operating curve (ROC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for both scoring systems were calculated.
Only 192 out of the 200 patients who satisfied the inclusion and exclusion criteria were included in the analysis. At the optimal cut-off threshold score of 7.5 derived from the ROC, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of the RIPASA score were 98.0 percent, 81.3 percent, 85.3 percent, 97.4 percent and 91.8 percent, respectively. At the cut-off threshold score of 7.0 for the Alvarado score, the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 68.3 percent, 87.9 percent, 86.3 percent, 71.4 percent and 86.5 percent, respectively. The RIPASA score correctly classified 98 percent of all patients confirmed with histological acute appendicitis to the high-probability group (RIPASA score greater than 7.5) compared with 68.3 percent with the Alvarado score (Alvarado score greater than 7.0; p-value less than 0.0001).
The RIPASA score at a cut-off threshold total score of 7.5 is a better diagnostic scoring system than the Alvarado score for the diagnosis of acute appendicitis in our local setting.
在亚洲人群中，Alvarado 评分诊断急性阑尾炎的准确性令人失望地较低。我们前瞻性地比较了 RIPASA 评分和 Alvarado 评分在诊断急性阑尾炎中的应用。
本研究纳入了 200 例因右髂窝疼痛就诊于急诊的连续患者。分别计算 RIPASA 和 Alvarado 评分，但阑尾切除术的决策基于临床判断。计算了两种评分系统的受试者工作特征曲线（ROC）、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
只有符合纳入和排除标准的 200 例患者中的 192 例被纳入分析。在 ROC 得出的最佳截断值 7.5 分处，RIPASA 评分的敏感性、特异性、PPV、NPV 和诊断准确性分别为 98.0%、81.3%、85.3%、97.4%和 91.8%。在 Alvarado 评分的截断值 7.0 分处，敏感性、特异性、PPV、NPV 和诊断准确性分别为 68.3%、87.9%、86.3%、71.4%和 86.5%。与 Alvarado 评分（Alvarado 评分>7.0；p 值<0.0001）相比，RIPASA 评分正确分类了 98%的所有经组织学证实的急性阑尾炎患者至高概率组（RIPASA 评分>7.5）。
在我们的本地环境中，RIPASA 评分在截断总分 7.5 分处是一种优于 Alvarado 评分的诊断评分系统，用于诊断急性阑尾炎。
