IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 18, Issue 6 Ser. 16 (June. 2019), PP 23-25 www.iosrjournals.org DOI: 10.9790/0853-1806162325 www.iosrjournals.org 23 | Page Comparative Study of Alvarado and RIPASA Scoring System in Diagnosing Acute Appendicitis: Dr Anjana Gandhi, Dr D.K.Sinha, Dr R.S.Sharma Corresponding Author: Dr Anjana Gandhi Abstract: Appendectomy is one of the most common surgeries conducted in any hospital. Despite modern advances, the diagnosis of appendicitis remains essentially clinical, requiring a mixture of observation clinical acumen and surgical science and as such it remains an enigmatic challenge and a reminder of the art of surgical diagnosis. A delay in performing an appendectomy runs the risk of appendicular perforation and sepsis, which in turn increases morbidity, hospital stay and mortality. A prospective comparison study was done for RIPASA and Alvarado scoring system by applying them to 150 patients who presented with right iliac fossa pain during the study period. Depending on clinical judgement and other investigations, appendectomy was done. A score of 7.5 is the optimal cut off threshold for RIPASA and 7 for Alvarado scoring system. Sensitivity and specificity of RIPASA scoring system is higher compared to Alvarado scoring system. The difference in ROC curve is 0.135 which is significant between two scoring system (p <0.001). Unnecessary and expensive radiological investigations can be avoided by using RIPASA score and thus reducing health care expenditure. This present study suggests that RIPASA score can be considered a superior score than the commonly used Alvarado score in terms of higher sensitivity and specificity in diagnosing acute appendicitis.TheRIPASA scoring system is a promising and has good sensitivity, specificity and diagnostic accuracy when compared to Alvarado scoring for Asian Population. RIPASA scoring system significantly reduces the number of negative laparotomies without increasing overall rate of appendicular perforation. It can work effectively in routine practice as an adjunct to surgical decision making in questionable acute appendicitis. It is simple to use and easy to apply since it relies only on history,clinicalexamination and basic lab investigations. It is cost-effective and can be used in all district general hospitals with basic lab facilities. Keywords: Pain abdomen . Vomiting . Fever . Acute appendicitis . Alvarado scoring . RIPASA scoring . Appendicular perforation . Negativeappendectomies --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 10-06-2019 Date of acceptance: 26-06-2019 --------------------------------------------------------------------------------------------------------------------------------------------------- I. Introduction The vermiform appendix is considered by most to be a vestigial organ; its importance in surgery results only from its propensity for inflammation, which results in the clinical syndrome known as „acute appendicitis‟. Appendectomy is one of the commonest surgeries conducted in any hospital. The incidence is 1.5 to 1.9 per 1000 in the population,with a male preponderance of 1.4 [1] Despite modern advances, the diagnosis of appendicitis remains essentially clinical, requiring a mixture of observation clinical acumen and surgical science and as such it remains an enigmatic challenge and a reminder of the art of surgical diagnosis. A delay in performing an appendectomy runs the risk of appendicular perforation and sepsis, which in turn increases morbidity, hospital stay and mortality. A number of scoring systems have been employed for aiding in diagnosis of acute appendicitis and its prompt management. These scores make use of clinical history, physical examination and laboratory findings. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score is a new diagnostic scoring system developed for the diagnosis of appendicitis and has been shown to have significantly higher sensitivity, specificity and diagnostic accuracy compared to Alvarado scoring system, particularly when applied to the Asian population. Although RIPASA score is more extensive than the Alvarado score, the latter did not contain certain paramsymptoms prior to presentation. These parameters are shown to affect sensitivity and specificity of Alvarado scoring system in the diagnosis of acute appendicitis [2]. II. Aim and Objectives To evaluate the accuracy of Alvarado and RIPASA scoring as an aid in surgical decision making in cases of possible appendicitis and in attenuating the „Negative Appendectomy‟ rates without increasing the risk of appendicular perforation. Comparing the sensitivity, specificity, positive predictive value and negative predictive value for both scoring systems. Correlate Alvarado and RIPASA scores with intraoperative, histopathological examination findings .