A Study to Determine the Efficacy of Alvarado and Raja Isteri Pengiran Anak Saleha Appendicitis Score in Diagnosing Acute Appendicitis

Background: Acute appendicitis is a common surgical emergency with a lifetime incidence of 7–8%. Diagnosis remains challenging due to overlapping clinical features with other abdominal and pelvic conditions, leading to delayed treatment or negative appendectomy. Clinical scoring systems such as the Alvarado and RIPASA scores have been developed to improve diagnostic accuracy. However, comparative validation in the Indian population remains limited. Aims and Objectives: To compare the diagnostic accuracy of the Alvarado and RIPASA scoring systems in predicting acute appendicitis in an Indian population, using histopathology as the gold standard. Materials and Methods: A prospective study was conducted from June 2022 to January 2024 at two tertiary care hospitals in New Delhi. A total of 121 patients aged 1–70 years with suspected acute appendicitis who underwent appendectomy were included. Both Alvarado and RIPASA scores were calculated at presentation. Cut-off values of ≥7 (Alvarado) and ≥7.5 (RIPASA) were used. Histopathological examination confirmed the diagnosis. Diagnostic performance was evaluated using Receiver Operating Characteristic (ROC) curve analysis to determine sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy. Results: Of 121 patients, 110 (90%) had histopathologically confirmed appendicitis. The mean Alvarado score was 6.5 ± 1.9, and the mean RIPASA score was 9.9 ± 1.9. ROC analysis showed good predictive ability for Alvarado (AUC = 0.789, P = 0.002) and excellent predictive ability for RIPASA (AUC = 0.991, P < 0.001). The Alvarado score demonstrated sensitivity 58.2%, specificity 81.8%, and overall accuracy 60.3%, whereas the RIPASA score showed sensitivity 97.3%, specificity 90.9%, and overall accuracy 96.7%. Conclusion: The RIPASA score demonstrated superior diagnostic accuracy compared to the Alvarado score and may serve as a more reliable clinical tool for diagnosing acute appendicitis in the Indian population.