Inteti Kamalesh, Shaik Mohammed Rafi, Ganapa Praveena, Gandi Preethi Shalini
General Surgery, NRI General & Superspeciality Hospital, Guntur, IND.
Community Medicine, Kurnool Medical College, Kurnool, IND.
Cureus. 2024 Aug 28;16(8):e68041. doi: 10.7759/cureus.68041. eCollection 2024 Aug.
Background Diagnosing acute appendicitis remains a problem, especially in teenagers with right lower quadrant pain. Imaging studies aid in accurate diagnosis but have limitations such as cost and availability. The Modified Alvarado Scoring System (MASS) is simple and cost-effective with fewer parameters. The Raja Isteri Pengiran Anak Saleha Appendicitis scoring system (RIPASA), designed for Asian populations, includes more parameters. This study compares the effectiveness of RIPASA and Alvarado scores in diagnosing acute appendicitis in a specific clinical setting. Objectives To compare the scoring systems of RIPASA and Alvarado in the diagnosis of acute appendicitis at a tertiary care hospital. Methods Data has been collected from all patients who attended the NRI general hospital emergency department and outpatient wing with acute appendicitis, admitted as inpatients based on clinical history and relevant investigations. Patients satisfying inclusion and exclusion criteria were selected and the basic investigations were done. Summary statistics were done using mean, standard deviation and proportions. Inferential statistics were done by using an independent t-test, kappa statistic, sensitivity and specificity with a 95% confidence interval (CI). All the measurements are done using the statistical package for the social sciences (SPSS) software version 21.0 (IBM Corp., Armonk, NY, USA) and open epidemiological (OpenEpi) software 3.01. A probability (p) <0.05 is considered as statistically significant. Results A total of 110 patients were analyzed for this study with a majority (39%) of them in the 21-30 age group. In our study, females (53%) outnumbered males (47%). Ultrasound findings in our cohort were acute appendicitis (93%), chronic appendicitis (2%) and normal appendix (5%). However, histopathology reported acute appendicitis (75%), chronic appendicitis (9%) and negative/non-specific (15%). The probability of appendicitis as predicted by Alvarado and RIPASA were 40% and 51% respectively. Definitive diagnosis of appendicitis was made in 16.4% with RIPASA whereas only 5.5% with Alvarado. When comparing the Alvarado and RIPASA scores, the sensitivity or true positive rate was higher for RIPASA (73.63%) than for Alvarado (50.55%). Conclusion There was a significant difference between the mean scores in Alvarado and RIPASA inpatients with scores suggestive of appendicitis and no appendicitis. Diagnostic accuracy was higher in RIPASA scoring compared to ALVARDO scoring. There was a significant statistical difference between the two scoring systems. When it comes to diagnosing in low-resource countries the study recommends a combination of Alvarado and RIPASA scoring systems.
诊断急性阑尾炎仍然是一个难题，尤其是对于右下腹疼痛的青少年。影像学检查有助于准确诊断，但存在成本和可用性等局限性。改良阿瓦拉多评分系统（MASS）简单且成本效益高，参数较少。为亚洲人群设计的拉贾·伊斯特丽·彭吉兰·阿娜克·萨利哈阑尾炎评分系统（RIPASA）包含更多参数。本研究比较了RIPASA和阿瓦拉多评分在特定临床环境中诊断急性阑尾炎的有效性。
比较RIPASA和阿瓦拉多评分系统在一家三级护理医院诊断急性阑尾炎的效果。
收集了所有因急性阑尾炎到NRI综合医院急诊科和门诊就诊的患者的数据，根据临床病史和相关检查作为住院患者收治。选择符合纳入和排除标准的患者并进行基本检查。使用均值、标准差和比例进行描述性统计。采用独立t检验、kappa统计量、敏感性和特异性以及95%置信区间（CI）进行推断性统计。所有测量均使用社会科学统计软件包（SPSS）21.0版（美国纽约州阿蒙克市IBM公司）和开放流行病学（OpenEpi）软件3.01进行。概率（p）<0.05被认为具有统计学意义。
本研究共分析了110例患者，其中大多数（39%）在21 - 30岁年龄组。在我们的研究中，女性（53%）多于男性（47%）。我们队列中的超声检查结果为急性阑尾炎（93%）、慢性阑尾炎（2%）和阑尾正常（5%）。然而，组织病理学报告急性阑尾炎（75%）、慢性阑尾炎（9%）和阴性/非特异性（15%）。阿瓦拉多和RIPASA预测阑尾炎的概率分别为40%和51%。RIPASA确诊阑尾炎的比例为16.4%，而阿瓦拉多仅为5.5%。比较阿瓦拉多和RIPASA评分时，RIPASA的敏感性或真阳性率（73.63%）高于阿瓦拉多（50.55%）。
阿瓦拉多和RIPASA评分中，提示阑尾炎和无阑尾炎的住院患者平均评分存在显著差异。与阿瓦拉多评分相比，RIPASA评分的诊断准确性更高。两种评分系统之间存在显著的统计学差异。在资源匮乏国家进行诊断时，该研究建议结合使用阿瓦拉多和RIPASA评分系统。
