Comparisons of the RIPASA Score with the ALVARADO and Paediatric Appendicitis Scores for the diagnosis of acute appendicitis in paediatric patients


Chee Fui CHONG 1, MAA AHMAD 1,  Vui Heng CHONG 2

1 Department of Surgery, and 2 Department of Internal Medicine, Raja Isteri Pengiran Anak Saleha Hospital, Brunei Darussalam



Introduction: Appendicitis is a common surgical emergency and diagnosis is usually straight forward. However, negative appendicectomy is still a problem. Several appendicitis predictive scores have been developed. To prospectively compare the RIPASA score with the Alvarado score and Pediatric Appendicitis score (PAS) for the diagnosis of acute appendicitis in pediatric patients presenting with right iliac fossa pain. Materials and Methods: Sixty-two pediatric patients aged between 1 years and 18 years old, presenting with RIF pain recruited to the Prospective study comparing RIPASA and Alvarado score were included for analysis. The RIPASA score, Alvarado score and PAS were derived during admission. Receiver operating curve (ROC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy and likelihood ratios for all three clinical scoring systems (CSSs) were derived. Results: The optimal cut-off threshold score derived for RIPASA score, Alvarado score and PAS were 7.5, 7.0 and 6.0 respectively. At their respective optimal cut-off threshold score, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of the RIPASA score were 96.7%, 84.4%, 85.3%, 96.4% and 90.9%, 70.0%, 84.4%, 80.8%, 75.0% and 82.0% for Alvarado score, and 70.0%, 75.0%, 72.4%, 72.7% and 81.0% for PAS respectively. The likelihood ratio for the RIPASA score at optimal cut-off threshold was 5.8, which was higher than the Alvarado score or PAS. The predicted negative appendicectomy rate for the RIPASA score (14.7%) was lower than the observed rate (25%), Alvarado score (19.2%) and PAS (27.5%). Conclusion: The RIPASA score at a cut-off threshold score of 7.5 is a better CSSs for diagnosing acute appendicitis in children, than the Alvarado score or PAS.


Keywords: Alvarado score, RIPASA score, Paediatric Appendicitis Score, Likelihood ratios, sensitivity, specificity


Correspondence author: Chong CF, Department of Surgery, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan BA1710, Brunei Darussalam. Tel: +673-2242424 Ext 6280; Fax: +673-2333270

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    Brunei Int Med J. 2016; 12 (1): 10-17