Sensibilidad y especificidad de las escalas diagnósticas en la apendicitis aguda. Estudio prospectivo / Sensitivity and specificity of the diagnostic scales in acute appendicitis. Prospective study

La Apendicitis Aguda se manifiesta cuando existe inflamación del apéndice cecal, representando una de las más notables causas de abdomen agudo con pronóstico quirúrgico en el mundo. Existen sistemas de puntuaciones que se han generado para su comprobación, mediante técnicas no invasivas, de fácil aplicación y reproducción; destacando entre ellas las escalas de ALVARADO, RIPASA, AIR, entre otras. Objetivo: Comparar la sensibilidad y especificidad de las escalas AIR Vs. RIPASA para el diagnóstico de la Apendicitis Aguda en el Hospital General Nacional "Dr. Ángel Larralde", período enero 2020 ­ diciembre 2022. Materiales: Estudio observacional, descriptivo y evaluativo, prospectivo y de corte transversal. Muestra fue intencional no probabilística, cumpliendo con los criterios de inclusión. Para la recolección de datos, se empleó la observación directa como técnica y como instrumentos las escalas AIR y RIPASA. Resultados: Muestra conformada por 192 pacientes, sin predisposición de géneros. Sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y exactitud diagnóstica AIR: 70%; 58,33%; 73,68%; 53,84%; 65,62%; RIPASA: 88,88%; 42,85%; 66,66%; 75%; 68,75%. Conclusiones: La exactitud diagnóstica para la escala de RIPASA fue ligeramente mayor que para AIR (68,75% vs. 65,62%), permitiendo afirmar que, en el grupo de estudio, resultó más conveniente la aplicación de la escala de RIPASA en pacientes sanos para el diagnóstico correcto de Apendicitis Aguda(AU)

Acute Appendicitis manifests when there is inflammation of the cecal appendix, representing one of the most notable causes of acute abdomen with surgical prognosis in the world. There are scoring systems that have been generated for verification, using non-invasive techniques that are easy to apply and reproduce; highlighting among them the scales of ALVARADO, RIPASA, AIR, among others.Objective : To compare the sensitivity and specificity of the AIR Vs. RIPASA scales for the diagnosis of Acute Appendicitis at the National General Hospital "Dr. Ángel Larralde", period January 2020 ­ December 2022. Materials: Observational, descriptive and evaluative, prospective and cross-sectional study. Sample was intentional, non-probabilistic, meeting the inclusion criteria. For data collection, direct observation was used as a technique and the AIR and RIPASA scales as instruments.Results : Sample made up of 192 patients, with no gender predisposition. Sensitivity, specificity, positive predictive value, negative predictive value, and AIR diagnostic accuracy: 70%; 58.33%; 73.68%; 53.84%; 65.62%; RIPASE: 88.88%; 42.85%; 66.66%; 75%; 68.75%.Conclusions : The diagnostic accuracy for the RIPASA scale was slightly higher than for AIR (68.75% vs. 65.62%), allowing us to affirm that, in the study group, the application of the RIPASA scale was more convenient in healthy patients for the correct diagnosis of Acute Appendicitis(AU)

Escala RIPASA para el diagnóstico de apendicitis aguda en el Hospital "General Freyre de Andrade" / RIPASA scale for the diagnosis of acute appendicitis in the Hospital "General Freyre de Andrade"

RESUMEN Introducción: La escala RIPASA fue elaborada para el diagnóstico de apendicitis aguda y ha demostrado buena sensibilidad y precisión diagnóstica, sobre todo en poblaciones asiáticas. Objetivo: Determinar la utilidad de la escala RIPASA para el diagnóstico de la apendicitis aguda. Métodos: Estudio observacional, analítico y prospectivo con 70 pacientes ingresados y operados con diagnóstico presuntivo de apendicitis aguda en el Hospital "General Freyre de Andrade" entre septiembre de 2015 y diciembre de 2017. Resultados: El 91,4 por ciento de los casos presentaron apendicitis por diagnóstico histológico. El síntoma, el signo y el dato de laboratorio más frecuentes fueron el dolor en fosa ilíaca derecha (97,1 por ciento), el rebote positivo (100 por ciento), y la leucocitosis (87,1 por ciento), respectivamente. Las diferencias entre los casos con y sin apendicitis para la puntuación de la escala fueron estadísticamente significativas. Predominaron los casos con puntajes altos (62,8 por ciento). A los 7,5 puntos la sensibilidad fue de 94 por ciento, la especificidad de 33 por ciento, la razón de verosimilitud positiva de 1,41, la razón de verosimilitud negativa de 0,19, y la precisión diagnóstica de 88,6 por ciento. El área bajo la curva de Características Operativas del Receptor fue de 0,81. Conclusiones: La escala RIPASA tuvo una buena sensibilidad y una moderada razón de verosimilitud negativa que permitirían descartar casos negativos con puntuaciones bajas. También exhibió una precisión diagnóstica y un desempeño discriminativo general aceptable. Sin embargo, la pobre especificidad y muy baja razón de verosimilitud positiva la hacen poco útil como medio diagnóstico único para la apendicitis aguda(AU)

ABSTRACT Introduction: The RIPASA scale was developed for the diagnosis of acute appendicitis and has shown good sensitivity and diagnostic precision, especially in Asian populations. Objective: To determine the utility of the RIPASA scale for the diagnosis of acute appendicitis. Methods: Observational, analytical and prospective study with 70 patients admitted and operated on with a presumptive diagnosis of acute appendicitis at the Hospital "General Freyre de Andrade" between September 2015 and December 2017. Results: 91.4 percent of the cases presented appendicitis due to histological diagnosis. The most frequent symptom, sign and laboratory data were pain in the right iliac fossa (97.1 percent), positive rebound (100 percent), and leukocytosis (87.1 percent), respectively. The differences between the cases with and without appendicitis for the scale score were statistically significant. Cases with high scores predominated (62.8 percent). At 7.5 points the sensitivity was 94 percent, the specificity was 33 percent, the positive likelihood ratio was 1.41, the negative likelihood ratio was 0.19, and the diagnostic precision was 88.6 percent. The area under the Receiver Operating Characteristics curve was 0.81. Conclusions: The RIPASA scale had good sensitivity and a moderate negative likelihood ratio that would allow us to rule out negative cases with low scores. It also exhibited diagnostic accuracy and acceptable overall discriminatory performance. However, the poor specificity and very low positive likelihood ratio make it of little use as a single diagnostic means for acute appendicitis(AU)

Raja Isteri Pengiran Anak Saleha Appendicitis score for the diagnosis of acute appendicitis in comparison with the Alvarado score

Background: Different scoring systems have been created to increase diagnostic accuracy, and they are inexpensive, non-invasive, and easy to use and reproduce. The modified Alvarado score is widely used in emergency services. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score was formulated in 2010 and has greater sensitivity and specificity. The aim of our article was to compare the usefulness of modified RIPASA score and Alvarado score in the diagnosis of patients with abdominal pain and suspected acute appendicitis.Methods: A prospective study was undertaken among 100 cases presenting with signs and symptoms suggestive of acute appendicitis, conducted at the Narayana medical college hospital, Nellore. The questionnaires used for the evaluation process were applied to the patients suspected of having appendicitis.Results: A total of 100 patients, 95% underwent laparoscopic procedure. The cut-off threshold point of the Alvarado score was set at 7.0, which yielded a sensitivity of 65% and a specificity of 52%. The positive predictive value was 65%. The cut-off threshold point of the modified RIPASA score was set at 7.5, which yielded 90% sensitivity and 72% specificity. The positive predictive value was 89% and the NPV was 30%.Conclusions: On comparing both the scores, sensitivity and specificity was higher for modified RIPASA score. The positive predictive value was higher for the Alvarado and negative predictive value was higher for RIPASA score. Bothe p values were statistically significant.