Syed Shams Ud Din1, Inayat Ullah Baig1, Mirza Tassawar Hussain1, Abdullah Sadiq1, Talha Humayun1, Umair Ahmad1, Aqsa Syed2

1Clinic of Surgery, Federal Government Polyclinic Hospital, Islamabad, Pakistan
2Clinic of Surgery, Akbar Niazi Teaching Hospital, Islamabad, Pakistan


Objective: This study aimed to compare Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado scoring to accurately identify acute appendicitis.

Material and Methods: A cross-sectional prospective study was carried out in the department of surgery. Patients were enrolled and scored using RIPASA and Alvarado scoring systems. Appendectomy was done, and the specimen was sent for histopathology examination, which was used as the gold standard for diagnosis. Among 400 recruits, 11 patients were lost to follow-up, giving us a sample size of 389 patients. The cut-off value for RIPASA and Alvarado scores was 7.5 and 7.0, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy in diagnosing acute appendicitis of both scores were analyzed using SPSS.

Results: Among 389 patients, 256 (66%) were males, and 277 (71%) were under the age of 40 years. RIPASA was more than 7.5 in 345 cases, while Alvarado was more than 7.0 in 261 patients. RIPASA score had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 95.8%, 87.9%, 98.9%, and 65.9%, respectively. In contrast, the ALVARADO score was 71.1% sensitive and 75.8% specific. RIPASA had a diagnostic accuracy of 95.12%, while Alvarado was only 71.46% accurate in diagnosing acute appendicitis.

Conclusion: Compared to the Alvarado scoring system, RIPASA is a better tool in terms of accuracy, sensitivity, and specificity for diagnosing acute appendicitis.

Keywords: Appendicitis, diagnostic technique, RIPASA score, Alvarado score, diagnostic accuracy

Cite this article as: Din SSU, Baig IU, Hussain MT, Sadiq A, Humayun T, Ahmed U, et al. RIPASA versus Alvarado score in the assessment of acute appendicitis: A prospective study. Turk J Surg 2023; 39 (3): 231-236.


Ethics Committee Approval

This study was approved by Federal Government Polyclinic Ethics Committee (Decision no: FGPC.1/12/2020, Date: 16.12.2021).

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - SSuD; Design - MTH, AS, TH, UA; Supervision - SSuD, IUB, MTH; Fundings - IUB; Materials - SSuD, IUB, MTH; Data Collection and/or Processing - AS, TH, UA, AS; Analysis and/or Interpretation - AS, TH, UA, AS; Literature Search - TH, UA, AS; Writing Manuscript - SSuD, AS, TH, UA, AS; Critical Reviews - SSuD, IUB, MTH, AS, TH, UA, AS.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.