Introduction: Acute appendicitis accounts for approximately 1% of all surgical operations.1 A prompt diagnosis and treatment is must to decrease in morbidity and mortality. Careful history and physical examination remains the most effective diagnostic modality2 . Diagnostic scoring systems have been developed in an attempt to improve the diagnostic accuracy of acute appendicitis.11,12 The most prominent of those scoring systems is Alvarado system which is based on clinical and laboratory evidence of acute appendicitis. Another scoring system RIPASA score has been derived for Asian countries that takes into consideration for age, sex, urine analysis, guarding, Rovsing sign, in addition to the variables in Alvarado score.13The confirmation of the diagnosis is done by histopathology post-operatively. This study is an attempt to compare both the scoring systems in diagnosing acute appendicitis and correlating both the scoring systems with the intraoperative and histopathological findings. Aim: To assess the accuracy of Alvardo score and RIPASSA score in diagnosing acute appendicitis and to correlate the two scoring systems with histopathological confirmation. Methods: A prospective study of 80 patients who were diagnosed clinically as acute appendicitis were assessed by Alvardo and RIPASSA scoring system. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy rates in both scoring systems with respect to histopathology was calculated. Relevant statistical tools were applied to compare the two scoring systems. Results: Alvarado scoring system is more specific (66.67%) as compared to RIPASA scoring system (33.33%).RIPASA scoring system is more sensitive (98.65%) as compared to Alvarado scoring system (94.59%).PPV of Alvarado scoring system is 97.22% as compared to 94.81% in RIPASA scoring system.NPV of RIPASA scoring system is 66.67% as compared to 50% in Alvarado scoring system. Diagnostic accuracy of RIPASA scoring system is 93.75% as compared with 92.50% in Alvarado scoring system. Negative appendectomy rate with Alvarado scoring system is 2.78% as compared to 5.19% with RIPASA scoring system.ROC analysis depicts cut off point for Alvarado score to be 7, for diagnosis with maximum sensitivity and specificity, similar to the original cutoff while RIPASA scoring cutoff point comes to be 7.5, consistent with the original cut off 7.5.There has been increase in scores in both the scoring systems with increase in severity on histopathological examination. Conclusion: Both Alvardo and RIPASSA score were equally good in predicting acute appendicitis and correlated well with the histopathology report and there is not much difference between the two scoring systems.
