EVALUATION OF THE RIPASA SCORE: A SCORING SYSTEM FOR THE DIAGNOSIS OF ACUTE APPENDICITIS
Introduction: The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score is a simple scoring system based on 18 parameters (four demographic, six clinical symptoms, five clinical signs and two clinical investigations), has been suggested by Dr. C.F. Chong of Singapore.
Materials and Methods: This prospective study of 120 patients with symptoms and signs of acute appendicitis in National Institute of Medical Sciences & Research under various surgical units, during the period of one and a half year. All the patients selected were scored as per RIPASA Scoring System. All the histopathologically positive appendix specimens (acute appendicitis) were considered as positive result. This positive result (acute appendicitis) was correlated with the RIPASA Score for further studies.
Results: Total 120 patients were taken, out of which 106 were operated. Out of all operated patients, positive HPE results were seen in 95 (89.62%) patients and negative HPE results were found in 11 (10.38%) patients. Taking 7.5 as cut off value of RIPASA scoring, assessment of correlation of HPE and RIPASA scoring was as follows:>/= 7.5 & Positive HPE – True Positive (89 cases), >/= 7.5 & Negative HPE – False Positive (4 cases), <7.5 & Negative HPE – True Negative (7 cases), <7.5 & Positive HPE – False Negative (6 cases). In our study, RIPASA Score got Sensitivity 93.63%, Specificity 63.64%, Positive Predictive Value 95.70% & Negative Predictive Value 53.85%. Thus, we reached on a conclusion that RIPASA score has high sensitivity and specificity in the diagnosis of acute appendicitis.
Conclusion: Simplicity, Reliability, Repeatability, Non-invasiveness are main characteristics of RIPASA scoring system. It is a safe diagnostic tool which can be applied quickly. A good clinical history and examination contains all the parameters of this scoring system. Therefore, a decision on the management can be made early to prevent further complications.
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