ABSTRACT
Background and objectives Appendicitis is a frequent cause of abdominal pain. Because of the limited availability of imaging services in many medical centers and an urge to reduce the substantial number of unnecessary appendectomies, several clinical diagnostic tools have been constructed. A novel diagnostic tool, referred to as the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score, has been created to assist in identifying acute appendicitis (AA) in Asian nations. The study aimed to assess the correlation between RIPASA scores and the severity of appendicitis as determined by pathological examination. Materials and methods The study was a prospective observational investigation undertaken in the Department of General Surgery at Muslim education society (MES) Medical College Perinthalmanna over 12 months. The study included all patients who had been diagnosed with AA and underwent appendectomy, provided they satisfied both the inclusion and exclusion criteria. An analysis was conducted on a convenience sample of 225 individuals using a prestructured proforma. The RIPASA scores were estimated before their surgery, taking into account their age, gender, symptoms, physical examination findings, and laboratory findings. These scores were subsequently contrasted with the histopathological results obtained after the appendectomy. The individuals were categorized into three groups according to their RIPASA scores. The lower-score category, scores between 4 and 7. The intermediate-score category consists of scores ranging from 7.5 to 11.5, while the higher-score category includes scores of 12 and above. These scores are correlated with the histopathology report (HPR) to determine the presence of appendicitis, perforated appendix, appendicular abscess, or the absence of pathology observed. Results The study population comprised of 137 (60.9%) males and 88 (39.1%) females. Among these, 177 individuals (78.7%) were younger than 40 years, while 48 individuals (21.3%) were older than 40 years. Out of 225 cases, 146 cases were AA (64.9%), 27 (12%) appendicular abscess cases, and 41 (18.2%) appendicular perforation cases. The normal appendix was noted in 11 out of 225 cases in the low-score group. The association between the histopathological report and RIPASA score was found to be statistically highly significant (p=0.000). In the low-score group, there were 14 cases of appendicitis (53.8%), one case of appendicular abscess (3.8%), a total of 11 cases without pathology observed (42.3%), and no reported instances of appendicular perforation. In the intermediate-score category, there were 121 cases of appendicitis (89.6%), 12 cases of appendicular abscess (8.9%), 2 cases of appendicular perforation (1.5%), and no reported cases in the non-pathology category. Among the high-score category, there were 11 cases of appendicitis (17.2%), 14 cases of appendicular abscess (21.9%), 39 cases of appendicular perforation (60.9%), and no reported instances of negative appendectomy. Conclusion The study has shown that the RIPASA scoring system had a high diagnostic efficacy in identifying AA. This scoring system is an effective, dependable, cost-effective, noninvasive, reproducible, and safe diagnostic technique that does not require additional expenses or concerns.
ABSTRACT
Introduction Acute appendicitis is the commonest abdominal surgical emergency globally. The most accepted management of acute appendicitis is surgical, either open or laparoscopic appendectomy. Overlapping clinical presentations with many genitourinary and gynecological conditions lead to difficulty in accurate diagnosis, making negative appendectomies an unwanted reality. With the advancement in technology, there have been constant efforts to minimize negative appendectomy rates (NAR) using imaging modalities like USG of the abdomen and the gold-standard imaging test, the contrast-enhanced computed tomography of the abdomen. Due to the cost incurred and the lesser availability of such imaging modalities and needed expertise in resource-poor settings, various clinical scoring systems were devised to accurately diagnose acute appendicitis and thereby decrease NAR. We conducted our study to determine the NAR between the Raja Isteri Pengiran Anak Saleha Appendicitis score (RIPASA) and the modified Alvarado (MA) scoring methods. Methods A prospective observational analytical study was conducted, including 50 patients presenting to our hospital with acute appendicitis and who underwent emergency open appendectomy. The need to operate was decided by the treating surgeon. Patients were stratified by both scores; the pre-operative scores were noted and were later compared with the histopathological diagnosis. Results A total of 50 clinically diagnosed patients with acute appendicitis were evaluated utilizing the RIPASA and the MA scores. The NAR was 2% using the RIPASA score vs 10% with the MA score. The sensitivity was 94.11% vs 70.58% (p<0.0001), the specificity was 93.75% vs 68.75% (p<0.0001), the positive predictive value (PPV) of 96.96% vs 82.75% (p<0.001), the negative predictive value (NPV) of 88.23% vs 52.38% (p<0.001), and NAR of 2% vs 10% (p<0.0001) in the RIPASA vs MA scoring method, respectively. Conclusions RIPASA score is highly efficacious and statistically significant in diagnosing acute appendicitis with higher PPV at higher scores and higher NPV with lower scores leading to decreased NAR compared with MA score.
ABSTRACT
Introducción: la apendicitis aguda es la enfermedad que mayores cirugías de urgencia demanda en el mundo. Objetivo: establecer la efectividad diagnóstica de la escala RIPASA (Raja Isteri Pengiran Anak Saleha Apendicitis) en historias clínicas de pacientes egresados con diagnóstico de apendicitis aguda. Método: se realizó un estudio transversal de evaluación de pruebas diagnósticas en un universo de 271 historias clínicas de pacientes con diagnóstico al egreso de apendicitis aguda, en los Hospitales Carlos Manuel de Céspedes y Celia Sánchez, Granma. El criterio de inclusión fue la descripción de cada uno de los reactivos de la escala en dichas historias. Se aplicó la escala de RIPASA. Los datos se procesaron en el sistema SPSS 21 versión. Resultados: la edad media de los pacientes fue de 31,79 años predominando el sexo masculino (56,83 por ciento). Del total de pacientes, 98,15 por ciento de los pacientes tuvieron un diagnóstico histológico de apendicitis aguda; 54,98 por ciento resultaron con alta probabilidad de apendicitis aguda, mientras que 29,89 por ciento resultaron en diagnóstico de apendicitis aguda según la escala. El análisis de los resultados de la escala RIPASA arrojó una sensibilidad de la escala del 87 por ciento. Conclusiones: la escala RIPASA demostró valores de sensibilidad diagnóstica en población cubana, acorde a lo reportado en la literatura. Se recomienda su utilización en el diagnóstico de apendicitis aguda(AU)
Introduction: Acute appendicitis is the illness demanding the greatest amount of surgeries worldwide. Objective: To establish the diagnostic effectiveness of the RIPASA scoring system in the clinical files of patients discharged with a diagnosis of acute appendicitis. Method: A cross-sectional study of assessment of diagnostic test was performed in a universe of 271 clinical files of patients with discharge after diagnosis of acute appendicitis in Carlos Manuel de Céspedes Hospital and Celia Sánchez Hospital of Granma Province. The inclusion criterion was the description of each reagent of the scoring system in this files. The RIPASA scoring system was applied, and the data were processed in the system SPSS version 21. Results: The patients' average age was 31.79 years, with a prevalence of the male sex (56.83 percent). 98.15 percent of the patients had a histological diagnostic of acute appendicitis. 54.98 percent of the patients presented high probability of acute appendicitis, while 28.89 percent of them had a diagnosis of acute appendicitis based on the scoring system. The analysis of the results of the RIPASA scoring system produced a scale sensibility at 87 percent. Conclusions: In the Cuban population, the RIPASA scoring system showed values of diagnostic sensibility consistent with what is reported in the scientific literature, a reason why its use is recommended for the diagnosis of acute appendicitis(AU)
Subject(s)
Humans , Male , Adult , Appendicitis/diagnosis , Appendicitis/surgery , Medical Records/statistics & numerical data , Cross-Sectional Studies , Diagnostic Techniques and Procedures/statistics & numerical dataABSTRACT
Introducción: la apendicitis aguda es la enfermedad que mayores cirugías de urgencia demanda en el mundo. Objetivo: establecer la efectividad diagnóstica de la escala RIPASA (Raja Isteri Pengiran Anak Saleha Apendicitis) en historias clínicas de pacientes egresados con diagnóstico de apendicitis aguda. Método: se realizó un estudio transversal de evaluación de pruebas diagnósticas en un universo de 271 historias clínicas de pacientes con diagnóstico al egreso de apendicitis aguda, en los Hospitales Carlos Manuel de Céspedes y Celia Sánchez, Granma. El criterio de inclusión fue la descripción de cada uno de los reactivos de la escala en dichas historias. Se aplicó la escala de RIPASA. Los datos se procesaron en el sistema SPSS 21 versión. Resultados: la edad media de los pacientes fue de 31,79 años predominando el sexo masculino (56,83 por ciento). Del total de pacientes, 98,15 por ciento de los pacientes tuvieron un diagnóstico histológico de apendicitis aguda; 54,98 por ciento resultaron con alta probabilidad de apendicitis aguda, mientras que 29,89 por ciento resultaron en diagnóstico de apendicitis aguda según la escala. El análisis de los resultados de la escala RIPASA arrojó una sensibilidad de la escala del 87 por ciento. Conclusiones: la escala RIPASA demostró valores de sensibilidad diagnóstica en población cubana, acorde a lo reportado en la literatura. Se recomienda su utilización en el diagnóstico de apendicitis aguda(AU)
Introduction: Acute appendicitis is the illness demanding the greatest amount of surgeries worldwide. Objective: To establish the diagnostic effectiveness of the RIPASA scoring system in the clinical files of patients discharged with a diagnosis of acute appendicitis. Method: A cross-sectional study of assessment of diagnostic test was performed in a universe of 271 clinical files of patients with discharge after diagnosis of acute appendicitis in Carlos Manuel de Céspedes Hospital and Celia Sánchez Hospital of Granma Province. The inclusion criterion was the description of each reagent of the scoring system in this files. The RIPASA scoring system was applied, and the data were processed in the system SPSS version 21. Results: The patients' average age was 31.79 years, with a prevalence of the male sex (56.83 percent). 98.15 percent of the patients had a histological diagnostic of acute appendicitis. 54.98 percent of the patients presented high probability of acute appendicitis, while 28.89 percent of them had a diagnosis of acute appendicitis based on the scoring system. The analysis of the results of the RIPASA scoring system produced a scale sensibility at 87 percent. Conclusions: In the Cuban population, the RIPASA scoring system showed values of diagnostic sensibility consistent with what is reported in the scientific literature, a reason why its use is recommended for the diagnosis of acute appendicitis(AU)
