Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis

Abdullah Shuaib; Ali Shuaib; Zainab Fakhra; Bader Marafi; Khalid Alsharaf; Abdullah Behbehani

摘要

BACKGROUND: Acute appendicitis is the most common surgical condition presented in emergency departments worldwide. Clinical scoring systems, such as the Alvarado and modified Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%–10%. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specifically for Asian populations. The aim of this study was to compare the modified Alvarado with the RIPASA scoring system in Kuwait population. METHODS: This study included 180 patients who underwent appendectomies and were documented as having "acute appendicitis" or "abdominal pain" in the operating theatre logbook (unit B) from November 2014 to March 2016. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic (ROC) curve of the modified Alvarado and RIPASA scoring systems were derived using SPSS statistical software. RESULTS: A total of 136 patients were included in this study according to our criteria. The cut-off threshold point of the modified Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specificity of 56%. The PPV was 89.3% and the NPV was 42.4%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded a 94.5% sensitivity and an 88% specificity. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modified Alvarado and RIPASA scoring systems, respectively. The negative appendectomy rate decreased significantly, from 18.4% to 10.7% for the modified Alvarado, and to 2.2% for the RIPASA scoring system, which was a significant difference (P<0.001) for both scoring systems. CONCLUSION: Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specificity than the modified Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations. The RIPASA scoring system is more accurate and specific than the modified Alvarado scoring system for Kuwait population.

机译：背景：急性阑尾炎是全世界急诊科中最常见的外科疾病。开发了临床评分系统，例如Alvarado和改良的Alvarado评分系统，目的是将阴性阑尾切除率降低到5％–10％。 Raja Isteri Pengiran Anak Saleha阑尾炎（RIPASA）评分系统于2008年建立，专门针对亚洲人口。这项研究的目的是将改良的Alvarado与RIPASA评分系统在科威特人口中进行比较。方法：本研究包括2014年11月至2016年3月的180例行阑尾切除术并在手术室日志（B单元）中记录为“急性阑尾炎”或“腹痛”的患者。敏感性，特异性，阳性预测值（PPV）），使用SPSS统计软件得出改良的Alvarado和RIPASA评分系统的阴性预测值（NPV），诊断准确性，阴性阴性阑尾切除术和受试者工作特征（ROC）曲线。结果：根据我们的标准，本研究共纳入136例患者。修改后的Alvarado得分的临界点设置为7.0，灵敏度为82.8％，特异性为56％。 PPV为89.3％，NPV为42.4％。 RIPASA分数的临界阈值设置为7.5，这产生了94.5％的灵敏度和88％的特异性。 PPV为97.2％，NPV为78.5％。改良的Alvarado和RIPASA评分系统的预测阴性阑尾切除率分别为10.7％和2.2％。阴性阑尾切除率显着降低，从改良Alvarado的18.4％降至10.7％，以及RIPASA评分系统的2.2％，这在两个评分系统中均存在显着差异（P <0.001）。结论：根据这项研究的结果，RIPASA评分是一个简单的评分系统，在亚洲人群中比改良的Alvarado评分系统具有更好的敏感性和特异性。它包含14个临床参数，可以从良好的患者病史，临床检查和实验室研究中获得。 RIPASA评分系统比修改后的科威特人口Alvarado评分系统更准确，更具体。

Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis

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