Comparison between the validity of the ‘Modified Alvarado’ and ‘Raja Isteri Pengiran Anak Saleha’ scores for the diagnosis of acute appendicitis

Abd El Maksoud, Walid M.; Bawahab, Mohammed A.; Al Shehri, Dafer M.; Mostafa, Osama; Ali, Hala F.; Alwail, Atheer A.; Alnashri, Hamad M.

doi:10.4103/1110-1121.199891

Comparison between the validity of the ‘Modified Alvarado’ and ‘Raja Isteri Pengiran Anak Saleha’ scores for the diagnosis of acute appendicitis

Authors

10.4103/1110-1121.199891

Abstract

Background
Clinical scores were designed to improve the diagnostic accuracy (DA) of acute appendicitis. However, their results vary when applied in different populations. This study aimed to compare the validity of the Modified Alvarado Score (MAS) with the Raja Isteri Pengiran Anak Saleha (RIPASA) score for diagnosing acute appendicitis in adult Saudi population.
Materials and methods
This study followed a prospective study design. It was carried out in Aseer Central Hospital, Abha, Saudi Arabia, during the period from November 2014 to May 2015. The study included 60 (aged >13 years) patients who were admitted in the Emergency Department and were clinically diagnosed as having acute appendicitis. Both the MAS and the RIPASA score were applied. A cutoff value for positive MAS was more than or equal to 7, and it was of at least 7.5 for positive RIPASA score. Surgical team members were blinded to the results of both scores. Operative findings describing the appendix, postoperative complications, hospital stay, and final diagnosis by histopathology were recorded.
Results
The study included 60 patients. There were 17 (28.3%) male and 43 (71.7%) female patients, with a mean age of 23.3±9.7 years. Negative appendectomy rate was 13.3%. The mean duration of hospital stay was 2.39±1.67 days. The MAS showed poor sensitivity (59.6%), poor DA (63.3%), and good specificity (87.5%). Compared with the MAS, the RIPASA score showed better sensitivity (96.2%) and DA (85.0%) when applied to our patients.
Conclusion
Neither the RIPASA score nor the MAS seems ideal for the accurate diagnosis of acute appendicitis when applied to patients in the southern region of Saudi Arabia.

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