Acute appendicitis - new diagnostic algorithm using RIPASA score and non-contrast Computeed Tomography Scan.

OBJECTIVE

To compare the accuracy of Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and modified Alvarado scores with that of non-contrast computed tomography scan and ultrasound of abdomen and pelvis.

METHODS

The observational correlational study was conducted at Manipal Hospital, Bengaluru, India, from April 1, 2014, to April 30, 2016, and comprised patients aged 18-60 years presenting with right lower quadrant pain to the emergency department. Modified Alvarado, RIPASA scores and ultrasound of abdomen and pelvis with optional non-contrast computed tomography scan reports were collected. Subjects underwent laparoscopic appendectomy, followed by histopathological analysis of specimen. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of diagnostic modalities in question were computed using SPSS 15.

RESULTS

Of the 206 patients, 126(61%) were males and 80(39%) were females. Overall mean mean age was 27.81±9.23 years. The diagnostic accuracy was 92.72% for RIPASA score and 59.22% for the modified Alvarado score. Ultrasound showed a high sensitivity of 94.65% but specificity of only 5.26%. Of the total, 25 patients underwent non-contrast computed tomography scan, and among them, 10(40%) were reported as cases of acute appendicitis. Diagnostic accuracy of non-contrast computed tomography scan was 100%.

CONCLUSION

Non-contrast computed tomography scan and RIPASA score were the most accurate diagnostic modalities..