Evaluation of Raja Isteri Pengiran Anak Saleha Appendicitis score: A new appendicitis scoring system

Abstract

Introduction: Acute appendicitis is the most common cause of an acute abdomen requiring surgery, the clinical presentation is typical in 50% of the cases, but the decision to explore the patient can sometimes be challenging. The diagnosis is based on history, clinical examination, and few laboratory investigations. To help the surgeon make diagnosis with certainty and reduce negative laparotomy rate, a number of clinical scoring systems are in vogue. The present study was undertaken toevaluate the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score in the diagnosis of acuteappendicitis. Materials and Methods: A prospective study was undertaken among 100 cases presenting with signs and symptoms suggestive of acute appendicitis. Validity of RIPASA score as a diagnostic test for appendicitis was established by calculating its sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) along with 95% confidence intervals (CIs), using intraoperative diagnosis confirmed by histopathology as gold standard. Results: RIPASA had sensitivity of 82.61% (95% CI 72.02, 89.76) and specificity of 88.89% (95% CI 67.2, 96.9). It had a PPV of 96.61% (95% CI 88.46, 99.07), NPV of 57.14% (95% CI 39.07, 73.49), and a diagnostic accuracy rate of 83.91% (95% CI 74.78, 90.17). Conclusion: The RIPASA score is a simple scoring system with a reasonable sensitivity and specificity for the diagnosis of acute appendicitis.