Noor Shehryar, Wahab Abdul, Afridi Gulsharif, Ullah Kaleem
Accident and Emergency Department, Khyber Teaching Hospital, Peshawar.
Department of Surgery, Lady Reading Hospital Peshawar, Pakistan.
J Ayub Med Coll Abbottabad. 2020 Jan-Mar;32(1):38-41.
The clinical diagnosis of acute appendicitis remains difficult despite the use of different scoring systems. A high rate of negative appendectomies is no longer acceptable. This study was aimed to compare RIPASA score and Alvarado score in Pakistani population for the diagnosis of acute appendicitis using histopathology as a gold standard.
This crosssectional prospective study was carried out from January to September 2018 in the Accident and Emergency Department and Department of Surgery, Khyber Teaching Hospital, Peshawar. Patients clinically suspected as acute appendicitis aided by routine ultrasound were included in the study. RIPASA and Alvarado scoring were done in all patients. After appendectomies, specimen was sent for histopathological examination. A score of 7.5 was considered as optimal cutoff threshold for RIPASA and 7 for Alvarado score. Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracies of both scores were calculated.
A total of 300 patients were included in the study. The mean age of patients was 28±10.0 years and there were 176 males. Sensitivity, Specificity of RIPASA score and Alvarado score was found to be 98.52% and 90%, and 68.15% and 80% respectively. Positive Predictive Value and NPV of RIPASA score was 98.88% and 97.67% as compared to 96.84% and 21.82% for Alvarado score. Diagnostic accuracy of RIPASA and Alvarado score was 97.67% and 69.33% respectively..
RIPASA scoring system is a more accurate, sensitive and specific indicator of diagnosing acute appendicitis as compared to Alvarado scoring system.
尽管使用了不同的评分系统，但急性阑尾炎的临床诊断仍然困难。高比例的阴性阑尾切除术已不再被接受。本研究旨在以组织病理学为金标准，比较巴基斯坦人群中RIPASA评分和阿尔瓦拉多评分对急性阑尾炎的诊断价值。
本横断面前瞻性研究于2018年1月至9月在白沙瓦开伯尔教学医院急诊科和外科进行。纳入临床怀疑为急性阑尾炎且经常规超声检查辅助的患者。对所有患者进行RIPASA和阿尔瓦拉多评分。阑尾切除术后，将标本送去做组织病理学检查。RIPASA评分的最佳截断阈值为7.5，阿尔瓦拉多评分为7。计算两种评分的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。
本研究共纳入300例患者。患者的平均年龄为28±10.0岁，男性176例。RIPASA评分和阿尔瓦拉多评分的敏感性分别为98.52%和90%，特异性分别为68.15%和80%。RIPASA评分的阳性预测值和NPV分别为98.88%和97.67%，而阿尔瓦拉多评分分别为96.84%和21.82%。RIPASA和阿尔瓦拉多评分的诊断准确性分别为97.67%和69.33%。
与阿尔瓦拉多评分系统相比，RIPASA评分系统是诊断急性阑尾炎更准确、敏感和特异的指标。
