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Correlación diagnóstica de la escala RIPASA en pacientes intervenidos quirúrgicamente por apendicitis aguda / Diagnostic correlation of the RIPASA score in patients operated on for acute appendicitis
Gasque, Rodrigo A; Moreno, Walter A; Vigilante, Gabriel E.
  • Gasque, Rodrigo A; Hospital Italiano de Córdoba. Córdoba. AR
  • Moreno, Walter A; Hospital Italiano de Córdoba. Córdoba. AR
  • Vigilante, Gabriel E; Hospital Italiano de Córdoba. Córdoba. AR
Rev. argent. cir ; 112(2): 178-184, 2020. tab
Article in Spanish | LILACS | ID: biblio-1125799
RESUMEN
Antecedentes La apendicitis aguda (AA) es la urgencia quirúrgica más frecuente alrededor del mundo. Su diagnóstico precoz y certero es fundamental para evitar cirugías innecesarias y complicaciones asociadas a su evolución natural.

Objetivo:

Determinar la sensibilidad y especificidad diagnóstica de la escala RIPASA en pacientes con sospecha clínica de apendicitis aguda. Material y

métodos:

Estudio analítico, transversal, observacional y retrospectivo; se incluyeron todas las piezas de apendicectomías de pacientes de ambos sexos mayores de 18 años operados con diagnóstico clínico de apendicitis aguda que consultaron entre el 1º de enero y el 31 de diciembre de 2017. Como procedimiento de referencia (gold standard) diagnóstico se analizaron los hallazgos histopatológicos del apéndice extirpado. Se aplicó la escala RIPASA a cada uno de los pacientes (punto de corte de 7,5). Se realizó estadística descriptiva y pruebas diagnósticas (sensibilidad, especificidad, valor predictivo positivo [VPP], valor predictivo negativo [VPN]).

Resultados:

Se incluyeron 68 apendicectomías. Cincuenta y siete muestras (83,82%) fueron positivas para apendicitis aguda. El promedio de edad fue 43,32 años. De los 38 hombres, 32 (84,21%) tuvieron diagnóstico histopatológico de AA. De las 30 mujeres, 25 (83,33%) tuvieron AA. Para la escala RIPASA, 54 pacientes tuvieron un resultado verdadero positivo (punto de corte ≥7,5 e histología positiva para AA) resultando con una sensibilidad del 93%, especificidad del 40%, VPP del 90%, VPN del 50%, razón de verosimilitud positiva de 1,55 y razón de verosimilitud negativa de 0,175.

Conclusión:

El puntaje (score) RIPASA ha demostrado una excelente sensibilidad y especificidad para el diagnóstico clínico de AA de manera rápida, simple y no invasiva.
ABSTRACT

Background:

Acute appendicitis (AA) is the most common surgical emergency worldwide. Its correct and early diagnosis is essential to avoid unnecessary surgeries and complications associated with its natural history.

Objective:

The aim of this study was to determine the diagnostic sensitivity and specificity of the RIPASA score in patients with suspected AA. Material and

methods:

This analytical, cross-sectional, observational and retrospective study included appendectomy specimens of patients of both sexes > 18 years operated on with clinical diagnosis of AA between January 1 and December 31, 2017. The histopathological examination of the appendectomy specimens was considered the gold standard diagnostic test. A score of 7.5 for the RIPASA score was chosen as cut-off value. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated.

Results:

A total of 68 appendectomies were included; 57 (83.82%) specimens were positive for acute appendicitis. Mean age was 43.32 years. The histological diagnosis of AA was present in 32 (84.21%) men and in 25 (83.33%) women. For the RIPASA score, 54 patients had a true positive result (cut-off point ≥ 7.5 and positive histology for AA) with a sensitivity of 93%, specificity of 40%, PPV of 90%, NPV of 50%, positive likelihood ratio of 1.55 and negative likelihood ratio of 0.175.

Conclusion:

The RIPASA score has demonstrated excellent sensitivity and specificity for the clinical diagnosis of AA in a fast, simple and non-invasive fashion.
Subject(s)

Full text: Available Index: LILACS (Americas) Main subject: Appendectomy / Appendicitis Type of study: Diagnostic study / Observational study / Prevalence study / Prognostic study / Risk factors / Screening study Limits: Adolescent / Adult / Aged / Female / Humans / Male Language: Spanish Journal: Rev. argent. cir Journal subject: General Surgery Year: 2020 Type: Article Affiliation country: Argentina Institution/Affiliation country: Hospital Italiano de Córdoba/AR

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Full text: Available Index: LILACS (Americas) Main subject: Appendectomy / Appendicitis Type of study: Diagnostic study / Observational study / Prevalence study / Prognostic study / Risk factors / Screening study Limits: Adolescent / Adult / Aged / Female / Humans / Male Language: Spanish Journal: Rev. argent. cir Journal subject: General Surgery Year: 2020 Type: Article Affiliation country: Argentina Institution/Affiliation country: Hospital Italiano de Córdoba/AR